Provider Demographics
NPI:1407154107
Name:ANDERSON, JUDY
Entity Type:Individual
Prefix:
First Name:JUDY
Middle Name:
Last Name:ANDERSON
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:31 HILLSIDE BLVD
Mailing Address - Street 2:
Mailing Address - City:BREWER
Mailing Address - State:ME
Mailing Address - Zip Code:04412-1248
Mailing Address - Country:US
Mailing Address - Phone:207-989-8636
Mailing Address - Fax:207-989-8651
Practice Address - Street 1:79 PARKWAY SOUTH
Practice Address - Street 2:PUPIL SERVICES OFFICE
Practice Address - City:BREWER
Practice Address - State:ME
Practice Address - Zip Code:04412
Practice Address - Country:US
Practice Address - Phone:207-989-8636
Practice Address - Fax:207-989-8651
Is Sole Proprietor?:Yes
Enumeration Date:2011-03-03
Last Update Date:2011-03-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist