Healthcare Provider Details

I. General information

NPI: 1891616298
Provider Name (Legal Business Name): LILLIAN JUDD
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/22/2026
Last Update Date: 07/22/2026
Certification Date: 07/22/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

300 SE REED MARKET RD STE 280
BEND OR
97702-3817
US

IV. Provider business mailing address

19928 HERON LOOP
BEND OR
97702-2223
US

V. Phone/Fax

Practice location:
  • Phone: 541-900-4285
  • Fax: 888-810-2993
Mailing address:
  • Phone: 541-848-1336
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code104100000X
TaxonomySocial Worker
License NumberA18447
License Number StateOR

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: