Provider Demographics
NPI:1427846187
Name:JUDKINS, CHANEL KATHLEEN
Entity type:Individual
Prefix:
First Name:CHANEL
Middle Name:KATHLEEN
Last Name:JUDKINS
Suffix:
Gender:
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:838 N 2400 W
Mailing Address - Street 2:
Mailing Address - City:PROVO
Mailing Address - State:UT
Mailing Address - Zip Code:84601-1228
Mailing Address - Country:US
Mailing Address - Phone:801-380-1429
Mailing Address - Fax:
Practice Address - Street 1:1220 N 500 W
Practice Address - Street 2:
Practice Address - City:LEHI
Practice Address - State:UT
Practice Address - Zip Code:84043-1104
Practice Address - Country:US
Practice Address - Phone:801-382-8676
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2025-04-30
Last Update Date:2025-04-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health