Provider Demographics
NPI:1487779120
Name:WEBER, JUDY WALKER (JUDY WEBER)
Entity type:Individual
Prefix:DR
First Name:JUDY
Middle Name:WALKER
Last Name:WEBER
Suffix:
Gender:F
Credentials:JUDY WEBER
Other - Prefix:DR
Other - First Name:JUDY
Other - Middle Name:W
Other - Last Name:WEBER
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:PHD
Mailing Address - Street 1:2300 E MILL PLAIN BLVD
Mailing Address - Street 2:
Mailing Address - City:VANCOUVER
Mailing Address - State:WA
Mailing Address - Zip Code:98661-4332
Mailing Address - Country:US
Mailing Address - Phone:360-694-3503
Mailing Address - Fax:360-694-1464
Practice Address - Street 1:2300 E MILL PLAIN BLVD
Practice Address - Street 2:
Practice Address - City:VANCOUVER
Practice Address - State:WA
Practice Address - Zip Code:98661-4332
Practice Address - Country:US
Practice Address - Phone:360-694-3503
Practice Address - Fax:360-694-1464
Is Sole Proprietor?:No
Enumeration Date:2007-03-20
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WAPY00000434103TA0400X, 103TB0200X, 103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Not Answered103TA0400XBehavioral Health & Social Service ProvidersPsychologistAddiction (Substance Use Disorder)
Not Answered103TB0200XBehavioral Health & Social Service ProvidersPsychologistCognitive & Behavioral
Not Answered103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
S27236Medicare UPIN
615505Medicare ID - Type Unspecified