Provider Demographics
NPI:1508057498
Name:JUDY, MONICA DAWN (MS CCC-SLP)
Entity Type:Individual
Prefix:
First Name:MONICA
Middle Name:DAWN
Last Name:JUDY
Suffix:
Gender:F
Credentials:MS CCC-SLP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:24935 KY AVE
Mailing Address - Street 2:
Mailing Address - City:CLAREMORE
Mailing Address - State:OK
Mailing Address - Zip Code:74019-4348
Mailing Address - Country:US
Mailing Address - Phone:918-706-4140
Mailing Address - Fax:918-343-9469
Practice Address - Street 1:2208 W DETROIT ST STE 101
Practice Address - Street 2:
Practice Address - City:BROKEN ARROW
Practice Address - State:OK
Practice Address - Zip Code:74012-3630
Practice Address - Country:US
Practice Address - Phone:918-806-0106
Practice Address - Fax:918-806-0113
Is Sole Proprietor?:No
Enumeration Date:2007-08-06
Last Update Date:2010-01-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OK3116235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist
Provider Identifiers
StateIdentifier IDID TypeIssuer
OK200049340AMedicaid