Provider Demographics
NPI:1174181465
Name:TUCKER, JUDY GAIL
Entity type:Individual
Prefix:
First Name:JUDY
Middle Name:GAIL
Last Name:TUCKER
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:JUDY
Other - Middle Name:GAIL
Other - Last Name:DEJOURNEY
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:360 W BENSON BLVD STE 300
Mailing Address - Street 2:
Mailing Address - City:ANCHORAGE
Mailing Address - State:AK
Mailing Address - Zip Code:99503-3953
Mailing Address - Country:US
Mailing Address - Phone:907-565-1200
Mailing Address - Fax:
Practice Address - Street 1:2804 BERING ST
Practice Address - Street 2:
Practice Address - City:ANCHORAGE
Practice Address - State:AK
Practice Address - Zip Code:99503-3820
Practice Address - Country:US
Practice Address - Phone:907-565-1200
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2019-05-31
Last Update Date:2020-01-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)