Provider Demographics
NPI:1407186307
Name:ADAMS, JUDITH (MA CCC-SLP)
Entity Type:Individual
Prefix:MRS
First Name:JUDITH
Middle Name:
Last Name:ADAMS
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 1:4628 BELLADONNA DR
Mailing Address - Street 2:
Mailing Address - City:FORT WORTH
Mailing Address - State:TX
Mailing Address - Zip Code:76123-1841
Mailing Address - Country:US
Mailing Address - Phone:682-239-9826
Mailing Address - Fax:
Practice Address - Street 1:4628 BELLADONNA DR
Practice Address - Street 2:
Practice Address - City:FORT WORTH
Practice Address - State:TX
Practice Address - Zip Code:76123-1841
Practice Address - Country:US
Practice Address - Phone:682-239-9826
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2009-12-28
Last Update Date:2022-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GASLP002040235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist