Provider Demographics
NPI:1033232335
Name:COLEMAN-WEBER, JUDY H (AUDIOLOGIST)
Entity Type:Individual
Prefix:
First Name:JUDY
Middle Name:H
Last Name:COLEMAN-WEBER
Suffix:
Gender:F
Credentials:AUDIOLOGIST
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4628 SUMMERHILL RD
Mailing Address - Street 2:
Mailing Address - City:TEXARKANA
Mailing Address - State:TX
Mailing Address - Zip Code:75503-2742
Mailing Address - Country:US
Mailing Address - Phone:903-794-5839
Mailing Address - Fax:903-794-1686
Practice Address - Street 1:4628 SUMMERHILL RD
Practice Address - Street 2:
Practice Address - City:TEXARKANA
Practice Address - State:TX
Practice Address - Zip Code:75503-2742
Practice Address - Country:US
Practice Address - Phone:903-794-5839
Practice Address - Fax:903-794-1686
Is Sole Proprietor?:Yes
Enumeration Date:2007-04-09
Last Update Date:2012-03-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX50323231H00000X
ARA167231H00000X
TX90040237600000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes237600000XSpeech, Language and Hearing Service ProvidersAudiologist-Hearing Aid Fitter
No231H00000XSpeech, Language and Hearing Service ProvidersAudiologist
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX507722OtherBLUE CROSS BLUE SHIELD
TX0945735Medicaid
TX507722OtherBLUE CROSS BLUE SHIELD