Provider Demographics
NPI:1417134420
Name:PLANK, JUDY A
Entity Type:Individual
Prefix:
First Name:JUDY
Middle Name:A
Last Name:PLANK
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 1:16311 GULF WINDS CT
Mailing Address - Street 2:
Mailing Address - City:WILDWOOD
Mailing Address - State:MO
Mailing Address - Zip Code:63040-1949
Mailing Address - Country:US
Mailing Address - Phone:636-458-4441
Mailing Address - Fax:636-458-8859
Practice Address - Street 1:16311 GULF WINDS CT
Practice Address - Street 2:
Practice Address - City:WILDWOOD
Practice Address - State:MO
Practice Address - Zip Code:63040-1949
Practice Address - Country:US
Practice Address - Phone:636-458-4441
Practice Address - Fax:636-458-8859
Is Sole Proprietor?:Yes
Enumeration Date:2008-01-22
Last Update Date:2008-01-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MO01018235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist