Judy Alethe Rudy, LCSW
Individual provider Active NPI Clinical Social Worker · Eagle Point, OR
NPI 1720567100 · NPPES record last updated Sep 28, 2018
Key facts
- NPI
- 1720567100
- Entity type
- Individual (NPI type 1)
- Primary specialty
- Clinical Social Worker 1041C0700X
- License
- L3625 (OR)
- Practice address
- 196 Glenwood Dr
Eagle Point, OR 97524-8595 - Phone
- (541) 261-1763
- Fax
- (541) 210-5162
- NPI assigned
- Aug 7, 2018
- Sex
- Female
- Sole proprietor
- No
Medicare participation
- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
- Eligible to order & refer
- Part B services: No · DME: Yes · Home health: No · Power mobility devices: No · Hospice: No
National Provider Directory
- Medicare enrollment (NPD)
- Yes
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| L3625 | OR | MD | Clinical Social Worker |
Specialties & licenses
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Social Worker | 104100000X | L3625 | OR | |
| Clinical Social Worker | 1041C0700X | L3625 | OR | Yes |
Addresses
Primary practice location
196 Glenwood Dr
Eagle Point, OR 97524-8595
Mailing address
196 Glenwood Dr
Eagle Point, OR 97524-8595
Phone (541) 261-1763
Other practice location 1
196 Glenwood Dr
Eagle Point, OR 97524-8595
Phone (541) 261-1763
Other identifiers
| Identifier | Type | State | Issuer |
|---|---|---|---|
| L3625 | Other | OR | CLINICAL SOCIAL WORK |
Other providers in Eagle Point, OR
- Robert L Nutting
- Wendy Robinson
- Rogue Community Health
- Rogue Community Health
- Rogue Community Health
- Amanda Salas
- Jennifer D Schnell
- Brandon Matthew Schultz
- Theresa L Sexton
- Dean Albert Shrock
All providers in Eagle Point, OR · Clinical Social Worker in Oregon
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Record last updated by the provider on Sep 28, 2018. Information in NPPES is self-reported and not verified by CMS.
- NUCC Health Care Provider Taxonomy: specialty names.
- Medicare Fee-For-Service Public Provider Enrollment (CMS/PECOS): enrollments, PAC IDs and benefit reassignments.
- Order and Referring (CMS).
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.