MEDICARE: DR. JUDY E PEABODY N.D.

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	175F00000X	Naturopath	704	OR
2	175L00000X	Homeopath	704	OR

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	022553	OTHER	OR	OREGON MEDICAL ASSISTANCE

General Provider Information

NPI Number	:	1164593638
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. JUDY E PEABODY N.D.

Provider Business Mailing Address
First Line	:	4085 SW 109TH AVE STE 200
Second Line	:
City	:	BEAVERTON
State	:	OR
Zip	:	97005-3000
Country	:	US
Telephone Number	:	503-643-1024
Fax Number	:

Provider Business Practice Location Address
First Line	:	4085 SW 109TH AVE STE 200
Second Line	:
City	:	BEAVERTON
State	:	OR
Zip	:	97005-3000
Country	:	US
Telephone Number	:	503-643-1024
Fax Number	:

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

Provider Enumeration Date	:	11/13/2006
Last Update Date	:	02/08/2026

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Directions to “ DR. JUDY E PEABODY N.D.” Practice Location

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