Provider Demographics
NPI:1083719702
Name:SEBASTIAN, JUDITH LYNN (MS CCC/SLP)
Entity Type:Individual
Prefix:MS
First Name:JUDITH
Middle Name:LYNN
Last Name:SEBASTIAN
Suffix:
Gender:F
Credentials:MS CCC/SLP
Other - Prefix:
Other - First Name:JUDITH
Other - Middle Name:L
Other - Last Name:SEBASTIAN
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:
Mailing Address - Street 1:8403 HEMLIG ST APT 103
Mailing Address - Street 2:
Mailing Address - City:KISSIMMEE
Mailing Address - State:FL
Mailing Address - Zip Code:34747-3068
Mailing Address - Country:US
Mailing Address - Phone:973-686-9333
Mailing Address - Fax:
Practice Address - Street 1:8403 HEMLIG ST APT 103
Practice Address - Street 2:
Practice Address - City:KISSIMMEE
Practice Address - State:FL
Practice Address - Zip Code:34747-3068
Practice Address - Country:US
Practice Address - Phone:973-686-9333
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-09-14
Last Update Date:2018-01-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ41YS00200900235Z00000X
FL14435235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist
Provider Identifiers
StateIdentifier IDID TypeIssuer
043797544OtherTIN