Provider Demographics
NPI:1396844783
Name:WISNIA, JUDITH FAYE (CCC-SLP)
Entity Type:Individual
Prefix:MS
First Name:JUDITH
Middle Name:FAYE
Last Name:WISNIA
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 1:111 S BEDFORD ST
Mailing Address - Street 2:SUITE 102
Mailing Address - City:BURLINGTON
Mailing Address - State:MA
Mailing Address - Zip Code:01803-5145
Mailing Address - Country:US
Mailing Address - Phone:781-272-2100
Mailing Address - Fax:781-272-0404
Practice Address - Street 1:111 S BEDFORD ST
Practice Address - Street 2:SUITE 102
Practice Address - City:BURLINGTON
Practice Address - State:MA
Practice Address - Zip Code:01803-5145
Practice Address - Country:US
Practice Address - Phone:781-272-2100
Practice Address - Fax:781-272-0404
Is Sole Proprietor?:No
Enumeration Date:2006-09-21
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA1553235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist