Provider Demographics
NPI:1336315522
Name:JANG, JUDY NESSELL (MA, CCC-SLP)
Entity Type:Individual
Prefix:MS
First Name:JUDY
Middle Name:NESSELL
Last Name:JANG
Suffix:
Gender:F
Credentials:MA, CCC-SLP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1413 GLEN EAGLES WAY
Mailing Address - Street 2:
Mailing Address - City:ORLANDO
Mailing Address - State:FL
Mailing Address - Zip Code:32804-6001
Mailing Address - Country:US
Mailing Address - Phone:813-727-7463
Mailing Address - Fax:
Practice Address - Street 1:1413 GLEN EAGLES WAY
Practice Address - Street 2:
Practice Address - City:ORLANDO
Practice Address - State:FL
Practice Address - Zip Code:32804-6001
Practice Address - Country:US
Practice Address - Phone:813-727-7463
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2008-05-07
Last Update Date:2020-03-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLSA6231235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist