MEDICARE: MS. JUDITH JODI MCINTOSH 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	MFC42850	CA
2	106H00000X	Marriage & Family Therapist	T2941	OR

General Provider Information

NPI Number	:	1700926045
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MS. JUDITH JODI MCINTOSH MFT

Provider Business Mailing Address
First Line	:	2795 NE JOHN OLSEN AVE APT J137
Second Line	:
City	:	HILLSBORO
State	:	OR
Zip	:	97124-6961
Country	:	US
Telephone Number	:	503-894-3556
Fax Number	:

Provider Business Practice Location Address
First Line	:	9600 SW OAK ST STE 500&520
Second Line	:
City	:	TIGARD
State	:	OR
Zip	:	97223-6583
Country	:	US
Telephone Number	:	503-894-3556
Fax Number	:

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

Provider Enumeration Date	:	02/07/2007
Last Update Date	:	06/26/2025

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