Provider Demographics
NPI:1457680324
Name:STASEK, JUDY
Entity Type:Individual
Prefix:MRS
First Name:JUDY
Middle Name:
Last Name:STASEK
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 1:176 COUNTRY AIRE LN
Mailing Address - Street 2:
Mailing Address - City:GREENWOOD
Mailing Address - State:IN
Mailing Address - Zip Code:46143-1506
Mailing Address - Country:US
Mailing Address - Phone:317-889-0565
Mailing Address - Fax:
Practice Address - Street 1:176 COUNTRY AIRE LN
Practice Address - Street 2:
Practice Address - City:GREENWOOD
Practice Address - State:IN
Practice Address - Zip Code:46143-1506
Practice Address - Country:US
Practice Address - Phone:317-889-0565
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2009-12-23
Last Update Date:2009-12-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN22002116A235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist