MEDICARE: JUDITH K EARLEY MFT

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
1	106H00000X	Marriage & Family Therapist	00230	IA

General Provider Information

NPI Number	:	1063579134
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	JUDITH K EARLEY MFT

Provider Business Mailing Address
First Line	:	722 WEST SIDE DRIVE
Second Line	:
City	:	IOWA CITY
State	:	IA
Zip	:	52246-4369
Country	:	US
Telephone Number	:	319-331-2327
Fax Number	:	319-341-7727

Provider Business Practice Location Address
First Line	:	722 WEST SIDE DRIVE
Second Line	:
City	:	IOWA CITY
State	:	IA
Zip	:	52246-4369
Country	:	US
Telephone Number	:	319-331-2327
Fax Number	:	319-341-7727

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	01/01/2007
Last Update Date	:	08/02/2011

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