Provider Demographics
NPI:1174835375
Name:METELUS, JUDITH D (CCC-SLP)
Entity Type:Individual
Prefix:MRS
First Name:JUDITH
Middle Name:D
Last Name:METELUS
Suffix:
Gender:F
Credentials:CCC-SLP
Other - Prefix:MS
Other - First Name:JUDITH
Other - Middle Name:L
Other - Last Name:DESROSIERS
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:CCC-SLP
Mailing Address - Street 1:19 BAKER HILL RD
Mailing Address - Street 2:9
Mailing Address - City:FREEVILLE
Mailing Address - State:NY
Mailing Address - Zip Code:13068-9623
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:19 BAKER HILL RD
Practice Address - Street 2:9
Practice Address - City:FREEVILLE
Practice Address - State:NY
Practice Address - Zip Code:13068-9623
Practice Address - Country:US
Practice Address - Phone:607-319-4930
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2010-07-06
Last Update Date:2010-10-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY0198871235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist