Healthcare Provider Details

I. General information

NPI: 1376150888
Provider Name (Legal Business Name): JESSICA LYNN JUDD MS
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

Provider Other Name: JESSICA LYNN WANDER

II. Dates (important events)

Enumeration Date: 09/29/2020
Last Update Date: 09/29/2020
Certification Date: 09/29/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

16316 DOVETAIL WAY
SPRING HILL FL
34610-6512
US

IV. Provider business mailing address

16316 DOVETAIL WAY
SPRING HILL FL
34610-6512
US

V. Phone/Fax

Practice location:
  • Phone: 412-576-9304
  • Fax:
Mailing address:
  • Phone: 412-576-9304
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: