Provider Demographics
NPI:1295849404
Name:FUDGE, LINDA MARLENE (AUD)
Entity Type:Individual
Prefix:
First Name:LINDA
Middle Name:MARLENE
Last Name:FUDGE
Suffix:
Gender:F
Credentials:AUD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:10535 JAGUAR PT
Mailing Address - Street 2:
Mailing Address - City:LITTLETON
Mailing Address - State:CO
Mailing Address - Zip Code:80124-9568
Mailing Address - Country:US
Mailing Address - Phone:303-795-5587
Mailing Address - Fax:303-795-3404
Practice Address - Street 1:7750 S BROADWAY
Practice Address - Street 2:SUITE 100
Practice Address - City:LITTLETON
Practice Address - State:CO
Practice Address - Zip Code:80122-2623
Practice Address - Country:US
Practice Address - Phone:303-795-5587
Practice Address - Fax:303-795-3404
Is Sole Proprietor?:Yes
Enumeration Date:2006-08-18
Last Update Date:2019-06-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CO73237600000X, 231H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes231H00000XSpeech, Language and Hearing Service ProvidersAudiologist
No237600000XSpeech, Language and Hearing Service ProvidersAudiologist-Hearing Aid Fitter
Provider Identifiers
StateIdentifier IDID TypeIssuer
CO73OtherCOLO LIC #