Provider Demographics
NPI:1053301374
Name:REESE, JUDITH L (PHD)
Entity Type:Individual
Prefix:DR
First Name:JUDITH
Middle Name:L
Last Name:REESE
Suffix:
Gender:F
Credentials:PHD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:19907 READING RD
Mailing Address - Street 2:
Mailing Address - City:LUTZ
Mailing Address - State:FL
Mailing Address - Zip Code:33558-5006
Mailing Address - Country:US
Mailing Address - Phone:813-948-2856
Mailing Address - Fax:
Practice Address - Street 1:1541 DALE MABRY HWY
Practice Address - Street 2:SUITE 201
Practice Address - City:LUTZ
Practice Address - State:FL
Practice Address - Zip Code:33548-3017
Practice Address - Country:US
Practice Address - Phone:813-949-1331
Practice Address - Fax:
Is Sole Proprietor?:Not Answered
Enumeration Date:2005-10-27
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLAY902231H00000X
FLSA2573235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Not Answered231H00000XSpeech, Language and Hearing Service ProvidersAudiologist
Not Answered235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist