Provider Demographics
NPI:1861779464
Name:JUDD-WALL, JAMIE K (ATP, BCBA)
Entity type:Individual
Prefix:MS
First Name:JAMIE
Middle Name:K
Last Name:JUDD-WALL
Suffix:
Gender:F
Credentials:ATP, BCBA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:223 W ANDERSON LN
Mailing Address - Street 2:SUITE A115
Mailing Address - City:AUSTIN
Mailing Address - State:TX
Mailing Address - Zip Code:78752-1131
Mailing Address - Country:US
Mailing Address - Phone:512-807-8955
Mailing Address - Fax:866-561-4982
Practice Address - Street 1:223 W ANDERSON LN
Practice Address - Street 2:SUITE A115
Practice Address - City:AUSTIN
Practice Address - State:TX
Practice Address - Zip Code:78752-1131
Practice Address - Country:US
Practice Address - Phone:512-807-8955
Practice Address - Fax:866-561-4982
Is Sole Proprietor?:Yes
Enumeration Date:2011-11-09
Last Update Date:2011-11-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103K00000XBehavioral Health & Social Service ProvidersBehavior Analyst