Provider Demographics
NPI:1154459477
Name:THURMOND, JUDITH A
Entity Type:Individual
Prefix:
First Name:JUDITH
Middle Name:A
Last Name:THURMOND
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:803 EAST HIGHWAY 72
Mailing Address - Street 2:
Mailing Address - City:FREDERICKTOWN
Mailing Address - State:MO
Mailing Address - Zip Code:63645-7292
Mailing Address - Country:US
Mailing Address - Phone:573-783-2570
Mailing Address - Fax:573-783-7045
Practice Address - Street 1:FREDERICKTOWN R-1 SCHOOL DIST
Practice Address - Street 2:803 EAST HIGHWAY 72
Practice Address - City:FREDERICKTOWN
Practice Address - State:MO
Practice Address - Zip Code:63645-7292
Practice Address - Country:US
Practice Address - Phone:573-783-2570
Practice Address - Fax:573-783-7045
Is Sole Proprietor?:No
Enumeration Date:2007-02-28
Last Update Date:2009-02-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MO104802235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist
Provider Identifiers
StateIdentifier IDID TypeIssuer
MO467463105Medicaid