Provider Demographics
NPI:1558417303
Name:BALLARD, JUDY W (SLP0969)
Entity Type:Individual
Prefix:MRS
First Name:JUDY
Middle Name:W
Last Name:BALLARD
Suffix:
Gender:F
Credentials:SLP0969
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:682 W SCHOOL BUS LN
Mailing Address - Street 2:
Mailing Address - City:SNOWFLAKE
Mailing Address - State:AZ
Mailing Address - Zip Code:85937-5262
Mailing Address - Country:US
Mailing Address - Phone:928-536-4156
Mailing Address - Fax:
Practice Address - Street 1:682 W SCHOOL BUS LN
Practice Address - Street 2:
Practice Address - City:SNOWFLAKE
Practice Address - State:AZ
Practice Address - Zip Code:85937-5262
Practice Address - Country:US
Practice Address - Phone:928-536-4156
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-01-26
Last Update Date:2007-07-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZSLP0969235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist
Provider Identifiers
StateIdentifier IDID TypeIssuer
AZ552100Medicaid