Provider Demographics
NPI:1003241050
Name:O'BRIEN, JUDIITH MARIE (MS, CCC-SLP)
Entity Type:Individual
Prefix:MISS
First Name:JUDIITH
Middle Name:MARIE
Last Name:O'BRIEN
Suffix:
Gender:F
Credentials:MS, CCC-SLP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3999 SUNDE RD NW
Mailing Address - Street 2:
Mailing Address - City:SILVERDALE
Mailing Address - State:WA
Mailing Address - Zip Code:98383-9662
Mailing Address - Country:US
Mailing Address - Phone:360-662-8100
Mailing Address - Fax:
Practice Address - Street 1:3999 SUNDE RD NW
Practice Address - Street 2:
Practice Address - City:SILVERDALE
Practice Address - State:WA
Practice Address - Zip Code:98383-9662
Practice Address - Country:US
Practice Address - Phone:360-662-8100
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2013-09-10
Last Update Date:2013-09-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WALL60337911235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist
Provider Identifiers
StateIdentifier IDID TypeIssuer
WALL60337911OtherWASHINGTON HEALTH DEPARTMENT