Healthcare Provider Details

I. General information

NPI: 1598841769
Provider Name (Legal Business Name): JUDE PARDEE PHD
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 10/31/2006
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

217 CAMINO DEL RINCON
SANTA FE NM
87506
US

IV. Provider business mailing address

PO BOX 40220
ALBUQUERQUE NM
87196-0220
US

V. Phone/Fax

Practice location:
  • Phone: 505-455-9922
  • Fax:
Mailing address:
  • Phone: 505-268-9131
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code103TF0200X
TaxonomyForensic Psychologist
License Number310
License Number StateNM

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: