Provider Demographics
NPI:1295857035
Name:WALTERS, JUDITH R (SLP-CCC, ATP)
Entity Type:Individual
Prefix:MRS
First Name:JUDITH
Middle Name:R
Last Name:WALTERS
Suffix:
Gender:F
Credentials:SLP-CCC, ATP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2202 SE OPAL WAY
Mailing Address - Street 2:
Mailing Address - City:STUART
Mailing Address - State:FL
Mailing Address - Zip Code:34997-6516
Mailing Address - Country:US
Mailing Address - Phone:772-286-6832
Mailing Address - Fax:772-286-6832
Practice Address - Street 1:2202 SE OPAL WAY
Practice Address - Street 2:
Practice Address - City:STUART
Practice Address - State:FL
Practice Address - Zip Code:34997-6516
Practice Address - Country:US
Practice Address - Phone:772-286-6832
Practice Address - Fax:772-286-6832
Is Sole Proprietor?:Yes
Enumeration Date:2007-04-04
Last Update Date:2007-07-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLSA 1829235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist