Provider Demographics
NPI:1003375353
Name:LAWLOR, JUDITH ANNE (CCC/SLP)
Entity Type:Individual
Prefix:
First Name:JUDITH
Middle Name:ANNE
Last Name:LAWLOR
Suffix:
Gender:F
Credentials:CCC/SLP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2652 HADDASSAH DR
Mailing Address - Street 2:
Mailing Address - City:NAPERVILLE
Mailing Address - State:IL
Mailing Address - Zip Code:60565-3068
Mailing Address - Country:US
Mailing Address - Phone:630-967-4742
Mailing Address - Fax:
Practice Address - Street 1:2652 HADDASSAH DR
Practice Address - Street 2:
Practice Address - City:NAPERVILLE
Practice Address - State:IL
Practice Address - Zip Code:60565-3068
Practice Address - Country:US
Practice Address - Phone:630-967-4742
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2019-03-17
Last Update Date:2019-03-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL146.001890235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language PathologistGroup - Single Specialty