Provider Demographics
NPI:1881556728
Name:JIM JUDKINS LISW LLC
Entity type:Organization
Organization Name:JIM JUDKINS LISW LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:BUSINESS OWNER
Authorized Official - Prefix:MR
Authorized Official - First Name:JAMES
Authorized Official - Middle Name:EVERETT
Authorized Official - Last Name:JUDKINS
Authorized Official - Suffix:
Authorized Official - Credentials:LISW
Authorized Official - Phone:641-485-2914
Mailing Address - Street 1:302 3RD ST
Mailing Address - Street 2:
Mailing Address - City:MELBOURNE
Mailing Address - State:IA
Mailing Address - Zip Code:50162-7722
Mailing Address - Country:US
Mailing Address - Phone:641-485-2914
Mailing Address - Fax:641-505-2680
Practice Address - Street 1:302 3RD ST
Practice Address - Street 2:
Practice Address - City:MELBOURNE
Practice Address - State:IA
Practice Address - Zip Code:50162-7722
Practice Address - Country:US
Practice Address - Phone:641-485-2914
Practice Address - Fax:641-505-2680
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2025-12-01
Last Update Date:2025-12-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QM0850XAmbulatory Health Care FacilitiesClinic/CenterAdult Mental Health