Provider Demographics
NPI:1578782736
Name:HEARNE, JUDY W (MCD,CCC-SLP)
Entity Type:Individual
Prefix:MRS
First Name:JUDY
Middle Name:W
Last Name:HEARNE
Suffix:
Gender:F
Credentials:MCD,CCC-SLP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:102 INDUSTRIAL PARK CIR
Mailing Address - Street 2:
Mailing Address - City:OCEAN SPRINGS
Mailing Address - State:MS
Mailing Address - Zip Code:39564-5836
Mailing Address - Country:US
Mailing Address - Phone:228-872-0705
Mailing Address - Fax:228-872-6996
Practice Address - Street 1:102 INDUSTRIAL PARK CIRCLE
Practice Address - Street 2:
Practice Address - City:OCEAN SPRINGS
Practice Address - State:MS
Practice Address - Zip Code:39564-5836
Practice Address - Country:US
Practice Address - Phone:228-872-0705
Practice Address - Fax:228-872-6996
Is Sole Proprietor?:Yes
Enumeration Date:2007-04-25
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MSS0166235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist
Provider Identifiers
StateIdentifier IDID TypeIssuer
MS0110640Medicaid
MS685381OtherACN