Provider Demographics
NPI:1033305552
Name:BALLARD, JUDY E (SLP)
Entity Type:Individual
Prefix:MRS
First Name:JUDY
Middle Name:E
Last Name:BALLARD
Suffix:
Gender:F
Credentials:SLP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6270 S 149TH WEST AVE
Mailing Address - Street 2:
Mailing Address - City:SAND SPRINGS
Mailing Address - State:OK
Mailing Address - Zip Code:74063-6315
Mailing Address - Country:US
Mailing Address - Phone:918-224-5835
Mailing Address - Fax:918-663-8754
Practice Address - Street 1:7608 E 91ST ST
Practice Address - Street 2:
Practice Address - City:TULSA
Practice Address - State:OK
Practice Address - Zip Code:74133-6014
Practice Address - Country:US
Practice Address - Phone:918-663-0606
Practice Address - Fax:918-663-8754
Is Sole Proprietor?:No
Enumeration Date:2007-09-18
Last Update Date:2007-09-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OK247235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist