Provider Demographics
NPI:1508298068
Name:HANLON, JUDY BULLARD (CCC-SLP)
Entity Type:Individual
Prefix:MRS
First Name:JUDY
Middle Name:BULLARD
Last Name:HANLON
Suffix:
Gender:F
Credentials:CCC-SLP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:61 MARNEL DR
Mailing Address - Street 2:
Mailing Address - City:SEVERNA PARK
Mailing Address - State:MD
Mailing Address - Zip Code:21146-2903
Mailing Address - Country:US
Mailing Address - Phone:410-424-8069
Mailing Address - Fax:
Practice Address - Street 1:MOTION PT GROUP
Practice Address - Street 2:645 BALTIMORE ANNAPOLIS BOULEVARD SUITE 111
Practice Address - City:SEVERNA PARK
Practice Address - State:MD
Practice Address - Zip Code:21146
Practice Address - Country:US
Practice Address - Phone:410-544-2500
Practice Address - Fax:410-384-9703
Is Sole Proprietor?:Yes
Enumeration Date:2013-08-06
Last Update Date:2019-01-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA2202006875235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist