MEDICARE: MS. JUDITH PAYNE DUEKER MSW, LCSW

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	1041C0700X	Clinical Social Worker	000168	MO

General Provider Information

NPI Number	:	1528232733
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MS. JUDITH PAYNE DUEKER MSW, LCSW

Provider Business Mailing Address
First Line	:	2004 S DEERBORN CIR
Second Line	:
City	:	COLUMBIA
State	:	MO
Zip	:	65203-1984
Country	:	US
Telephone Number	:	573-445-3850
Fax Number	:

Provider Business Practice Location Address
First Line	:	3401 BERRYWOOD DR
Second Line	:	SUITE 204
City	:	COLUMBIA
State	:	MO
Zip	:	65201-6515
Country	:	US
Telephone Number	:	573-777-8400
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	04/17/2008
Last Update Date	:	04/17/2008

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