Provider Demographics
NPI:1609902139
Name:JUD, CORAL M (AUD)
Entity Type:Individual
Prefix:DR
First Name:CORAL
Middle Name:M
Last Name:JUD
Suffix:
Gender:F
Credentials:AUD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:9 N 18TH ST
Mailing Address - Street 2:
Mailing Address - City:FORT DODGE
Mailing Address - State:IA
Mailing Address - Zip Code:50501-4227
Mailing Address - Country:US
Mailing Address - Phone:515-573-7821
Mailing Address - Fax:515-573-8849
Practice Address - Street 1:9 N 18TH ST
Practice Address - Street 2:
Practice Address - City:FORT DODGE
Practice Address - State:IA
Practice Address - Zip Code:50501-4227
Practice Address - Country:US
Practice Address - Phone:515-573-7821
Practice Address - Fax:515-573-8849
Is Sole Proprietor?:Yes
Enumeration Date:2007-02-26
Last Update Date:2007-07-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IA347231H00000X
IA216237700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Not Answered231H00000XSpeech, Language and Hearing Service ProvidersAudiologist
Not Answered237700000XSpeech, Language and Hearing Service ProvidersHearing Instrument Specialist
Provider Identifiers
StateIdentifier IDID TypeIssuer
IA0935916Medicaid
IA0085456Medicaid