Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 102L00000X | Psychologist | 604 | OR |
N | 103T00000X | Psychologist | 604 | OR |
N | 103TC1900X | Counseling Psychologist | 604 | OR |
NPI | 1053482109 |
---|---|
Provider Name | Dr. Judith K Clements |
First Address | Bend, OR 97702-1010 |
Second Address | Bend, OR 97702-1010 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 12/11/2006 |
Last Update Date | 08/07/2007 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
R13587 | (02) | OR |