Individual
JILL R JUDGE
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
LCSW
Contact information
Practice address
20531 DARDEN RD, SOUTH BEND, IN 46637-2915
(574) 272-0100
Mailing address
4860 ROBB ST, SUITE 201, WHEAT RIDGE, CO 80033-2184
(303) 278-7418
(888) 341-5050
Taxonomy
Speciality
Code
Description
License number
State
1041C0700X
Clinical Social Worker
Primary
34006423A
IN
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
12541871
CAQH PIN
IN
01
—
34006423A
PROFESSIONAL LICENSE
IN
Enumeration date
09/05/2012
Last updated
10/08/2013
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