Provider Demographics
NPI:1437481926
Name:CORDELL, JUDY MARGARETE (LPA)
Entity type:Individual
Prefix:MS
First Name:JUDY
Middle Name:MARGARETE
Last Name:CORDELL
Suffix:
Gender:F
Credentials:LPA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:22450 EAGLE GLACIER LOOP
Mailing Address - Street 2:
Mailing Address - City:EAGLE RIVER
Mailing Address - State:AK
Mailing Address - Zip Code:99577-9531
Mailing Address - Country:US
Mailing Address - Phone:907-317-4574
Mailing Address - Fax:
Practice Address - Street 1:1825 S CHUGACH ST
Practice Address - Street 2:
Practice Address - City:PALMER
Practice Address - State:AK
Practice Address - Zip Code:99645-6795
Practice Address - Country:US
Practice Address - Phone:907-376-4000
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2010-02-08
Last Update Date:2010-02-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AKA457103T00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103T00000XBehavioral Health & Social Service ProvidersPsychologist