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NPI Code Detail

MEDICARE: JUDI WILLINGHAM

MEDICARE: JUDI WILLINGHAM
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
1101YA0400XAddiction (Substance Use Disorder) Counselor96-10-174OR

General Provider Information

NPI Number : 1982061578
Entity Type Code : Individual
Provider Name (Legal Business Name) : JUDI WILLINGHAM
Provider Business Mailing Address
First Line : 3397 DELTA WATERS RD
Second Line :
City : MEDFORD
State : OR
Zip : 97504-5852
Country : US
Telephone Number : 541-772-4648
Fax Number : 541-858-7593
Provider Business Practice Location Address
First Line : 3397 DELTA WATERS RD
Second Line :
City : MEDFORD
State : OR
Zip : 97504-5852
Country : US
Telephone Number : 541-772-4648
Fax Number : 541-858-7593
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 01/27/2016
Last Update Date : 01/27/2016

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