Provider Demographics
NPI:1548283096
Name:DEAN, JUDITH C (PHD)
Entity type:Individual
Prefix:
First Name:JUDITH
Middle Name:C
Last Name:DEAN
Suffix:
Gender:F
Credentials:PHD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:P.O. BOX 111810
Mailing Address - Street 2:
Mailing Address - City:ANCHORAGE
Mailing Address - State:AK
Mailing Address - Zip Code:99503-2070
Mailing Address - Country:US
Mailing Address - Phone:907-929-4009
Mailing Address - Fax:907-929-4009
Practice Address - Street 1:1400 W. BENSON BLVD., SUITE 315
Practice Address - Street 2:
Practice Address - City:ANCHORAGE
Practice Address - State:AK
Practice Address - Zip Code:99503-0000
Practice Address - Country:US
Practice Address - Phone:907-929-4009
Practice Address - Fax:907-929-4902
Is Sole Proprietor?:No
Enumeration Date:2006-07-25
Last Update Date:2013-06-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AK403103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
AKMH6578Medicaid