Individual
MS. KATHLEEN MARY JUDGE
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
LMT
Contact information
Practice address
3241 NE BROADWAY ST, PORTLAND, OR 97232-1855
(503) 282-8582
(503) 460-0814
Mailing address
17 NE 62ND AVE, PORTLAND, OR 97213-3835
(503) 233-8457
Taxonomy
Speciality
Code
Description
License number
State
174400000X
Specialist
Primary
4731
OR
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
30 2373
CHIROPRACTIC ASSISTANT
OR
01
—
4731
LICENSED MASSAGE THERAPIS
OR
Enumeration date
12/22/2006
Last updated
07/08/2007
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