Healthcare Provider Details

I. General information

NPI: 1881556728
Provider Name (Legal Business Name): JIM JUDKINS LISW LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 12/01/2025
Last Update Date: 12/01/2025
Certification Date: 11/30/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

302 3RD ST
MELBOURNE IA
50162-7722
US

IV. Provider business mailing address

302 3RD ST
MELBOURNE IA
50162-7722
US

V. Phone/Fax

Practice location:
  • Phone: 641-485-2914
  • Fax: 641-505-2680
Mailing address:
  • Phone: 641-485-2914
  • Fax: 641-505-2680

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QM0850X
TaxonomyAdult Mental Health Clinic/Center
License Number
License Number State

VIII. Authorized Official

Name: MR. JAMES EVERETT JUDKINS
Title or Position: BUSINESS OWNER
Credential: LISW
Phone: 641-485-2914