Provider Demographics
NPI:1831331487
Name:JUDY SIMONSEN LLC
Entity type:Organization
Organization Name:JUDY SIMONSEN LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:MS
Authorized Official - First Name:JUDITH
Authorized Official - Middle Name:MARIE
Authorized Official - Last Name:SIMONSEN
Authorized Official - Suffix:
Authorized Official - Credentials:LAC, PT
Authorized Official - Phone:503-806-6184
Mailing Address - Street 1:819 SE MORRISON ST
Mailing Address - Street 2:SUITE 120
Mailing Address - City:PORTLAND
Mailing Address - State:OR
Mailing Address - Zip Code:97214-6307
Mailing Address - Country:US
Mailing Address - Phone:503-806-6184
Mailing Address - Fax:503-445-7997
Practice Address - Street 1:819 SE MORRISON ST
Practice Address - Street 2:SUITE 120
Practice Address - City:PORTLAND
Practice Address - State:OR
Practice Address - Zip Code:97214-6307
Practice Address - Country:US
Practice Address - Phone:503-806-6184
Practice Address - Fax:503-445-7997
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2009-03-28
Last Update Date:2009-03-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OR1668261QP2000X
ORAC00868261QH0100X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QH0100XAmbulatory Health Care FacilitiesClinic/CenterHealth Service
No261QP2000XAmbulatory Health Care FacilitiesClinic/CenterPhysical Therapy