Provider Demographics
NPI:1477815561
Name:DIEM, JUDITH HEATH (MA,CCC/SLP)
Entity Type:Individual
Prefix:MRS
First Name:JUDITH
Middle Name:HEATH
Last Name:DIEM
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 1:24 GATES RD
Mailing Address - Street 2:
Mailing Address - City:SOMERSET
Mailing Address - State:NJ
Mailing Address - Zip Code:08873-2258
Mailing Address - Country:US
Mailing Address - Phone:732-873-2032
Mailing Address - Fax:732-649-3550
Practice Address - Street 1:24 GATES RD
Practice Address - Street 2:
Practice Address - City:SOMERSET
Practice Address - State:NJ
Practice Address - Zip Code:08873-2258
Practice Address - Country:US
Practice Address - Phone:732-873-2032
Practice Address - Fax:732-649-3550
Is Sole Proprietor?:Yes
Enumeration Date:2012-06-13
Last Update Date:2012-06-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ41YS00028100235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist