Provider Demographics
NPI:1720266489
Name:BANKER, JUDITH D (MA,LLP)
Entity type:Individual
Prefix:MS
First Name:JUDITH
Middle Name:D
Last Name:BANKER
Suffix:
Gender:F
Credentials:MA,LLP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:111 N 1ST ST
Mailing Address - Street 2:SUITE 2
Mailing Address - City:ANN ARBOR
Mailing Address - State:MI
Mailing Address - Zip Code:48104-1397
Mailing Address - Country:US
Mailing Address - Phone:734-668-8448
Mailing Address - Fax:734-996-0998
Practice Address - Street 1:111 N 1ST ST
Practice Address - Street 2:SUITE 2
Practice Address - City:ANN ARBOR
Practice Address - State:MI
Practice Address - Zip Code:48104-1397
Practice Address - Country:US
Practice Address - Phone:734-668-8448
Practice Address - Fax:734-996-0998
Is Sole Proprietor?:Yes
Enumeration Date:2008-02-05
Last Update Date:2008-02-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI002682103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical