Provider Demographics
NPI:1265660930
Name:GELDERMAN, JUDITH CHRISTENSEN (CCC-SLP)
Entity Type:Individual
Prefix:MS
First Name:JUDITH
Middle Name:CHRISTENSEN
Last Name:GELDERMAN
Suffix:
Gender:F
Credentials:CCC-SLP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6776 LAKE DR
Mailing Address - Street 2:220
Mailing Address - City:LINO LAKES
Mailing Address - State:MN
Mailing Address - Zip Code:55014-1192
Mailing Address - Country:US
Mailing Address - Phone:651-784-7007
Mailing Address - Fax:651-784-7992
Practice Address - Street 1:6776 LAKE DR
Practice Address - Street 2:220
Practice Address - City:LINO LAKES
Practice Address - State:MN
Practice Address - Zip Code:55014-1192
Practice Address - Country:US
Practice Address - Phone:651-784-7007
Practice Address - Fax:651-784-7992
Is Sole Proprietor?:No
Enumeration Date:2009-07-01
Last Update Date:2012-02-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MN8490235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist