Basic Information
| Provider Information | |||||||||
| NPI: | 1801423876 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | SCHUMACKER | ||||||||
| FirstName: | JUDY | ||||||||
| MiddleName: | MARIE | ||||||||
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| Credential: | LCSW | ||||||||
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| Mailing Information | |||||||||
| Address1: | 14155 SE 118TH DR | ||||||||
| Address2: | |||||||||
| City: | CLACKAMAS | ||||||||
| State: | OR | ||||||||
| PostalCode: | 970155759 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 5036985531 | ||||||||
| FaxNumber: | |||||||||
| Practice Location | |||||||||
| Address1: | 10150 SE 32ND AVE | ||||||||
| Address2: | |||||||||
| City: | MILWAUKIE | ||||||||
| State: | OR | ||||||||
| PostalCode: | 972226516 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 5035138300 | ||||||||
| FaxNumber: | |||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 03/26/2020 | ||||||||
| LastUpdateDate: | 03/26/2020 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | N | ||||||||
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| NPICertificationDate: | 03/26/2020 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 1041C0700X | L2191 | OR | Y | Behavioral Health & Social Service Providers | Social Worker | Clinical |
No ID Information.