Provider Demographics
NPI:1700926045
Name:MCINTOSH, JUDITH JODI (MFT)
Entity type:Individual
Prefix:MS
First Name:JUDITH
Middle Name:JODI
Last Name:MCINTOSH
Suffix:
Gender:F
Credentials:MFT
Other - Prefix:
Other - First Name:JUDITH
Other - Middle Name:MARIE
Other - Last Name:BURKE
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:2795 NE JOHN OLSEN AVE APT J137
Mailing Address - Street 2:
Mailing Address - City:HILLSBORO
Mailing Address - State:OR
Mailing Address - Zip Code:97124-6961
Mailing Address - Country:US
Mailing Address - Phone:503-894-3556
Mailing Address - Fax:
Practice Address - Street 1:9600 SW OAK ST STE 500&520
Practice Address - Street 2:
Practice Address - City:TIGARD
Practice Address - State:OR
Practice Address - Zip Code:97223-6583
Practice Address - Country:US
Practice Address - Phone:503-894-3556
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-02-07
Last Update Date:2025-06-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAMFC42850106H00000X
ORT2941106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist