Provider Demographics
NPI:1053567727
Name:JUDY, VANESSA MAE (MA CCC-SLP)
Entity type:Individual
Prefix:
First Name:VANESSA
Middle Name:MAE
Last Name:JUDY
Suffix:
Gender:F
Credentials:MA CCC-SLP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1843 FAR VIEW PL
Mailing Address - Street 2:
Mailing Address - City:LANCASTER
Mailing Address - State:OH
Mailing Address - Zip Code:43130-7800
Mailing Address - Country:US
Mailing Address - Phone:614-404-6663
Mailing Address - Fax:
Practice Address - Street 1:300 ARLINGTON AVE
Practice Address - Street 2:
Practice Address - City:LOGAN
Practice Address - State:OH
Practice Address - Zip Code:43138-1708
Practice Address - Country:US
Practice Address - Phone:740-385-2155
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2008-08-14
Last Update Date:2008-08-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OHSP 9109235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist