Provider Demographics
NPI:1235825910
Name:DAUGHERITY, JUDY (MS CCC-SLP)
Entity Type:Individual
Prefix:
First Name:JUDY
Middle Name:
Last Name:DAUGHERITY
Suffix:
Gender:F
Credentials:MS CCC-SLP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3608 SADIE DR
Mailing Address - Street 2:
Mailing Address - City:YUKON
Mailing Address - State:OK
Mailing Address - Zip Code:73099-3197
Mailing Address - Country:US
Mailing Address - Phone:405-537-7652
Mailing Address - Fax:
Practice Address - Street 1:3608 SADIE DR
Practice Address - Street 2:
Practice Address - City:YUKON
Practice Address - State:OK
Practice Address - Zip Code:73099-3197
Practice Address - Country:US
Practice Address - Phone:405-537-7652
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2023-04-14
Last Update Date:2023-04-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OK5376235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language PathologistGroup - Single Specialty