Provider Demographics
NPI:1417077025
Name:JUDGE, PAMELA MONROE (MA,, CCC-SLP)
Entity Type:Individual
Prefix:
First Name:PAMELA
Middle Name:MONROE
Last Name:JUDGE
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 1:600 MOURNING DOVE CIR
Mailing Address - Street 2:
Mailing Address - City:LAKE MARY
Mailing Address - State:FL
Mailing Address - Zip Code:32746-3960
Mailing Address - Country:US
Mailing Address - Phone:407-324-7141
Mailing Address - Fax:
Practice Address - Street 1:142 W LAKEVIEW AVE STE 2010
Practice Address - Street 2:
Practice Address - City:LAKE MARY
Practice Address - State:FL
Practice Address - Zip Code:32746-2903
Practice Address - Country:US
Practice Address - Phone:407-323-6955
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-03-29
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLSA 4434235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL8835080Medicaid