Provider Demographics
NPI:1619275054
Name:HANCOCK, JUDITH HANSON (CCC-SLP)
Entity Type:Individual
Prefix:MRS
First Name:JUDITH
Middle Name:HANSON
Last Name:HANCOCK
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 1:435 GLENWOOD RD
Mailing Address - Street 2:
Mailing Address - City:BINGHAMTON
Mailing Address - State:NY
Mailing Address - Zip Code:13905-1606
Mailing Address - Country:US
Mailing Address - Phone:607-763-3318
Mailing Address - Fax:607-763-3214
Practice Address - Street 1:435 GLENWOOD RD
Practice Address - Street 2:
Practice Address - City:BINGHAMTON
Practice Address - State:NY
Practice Address - Zip Code:13905-1606
Practice Address - Country:US
Practice Address - Phone:607-763-3318
Practice Address - Fax:607-763-3214
Is Sole Proprietor?:No
Enumeration Date:2011-03-09
Last Update Date:2011-03-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY004817-1235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist
Provider Identifiers
StateIdentifier IDID TypeIssuer
01033362OtherCERTIFICATE OF CLINICAL COMPETENCE - SPEECH-LANGUAGE PATHOLOGIST (CCC-SLP)
004817-1OtherNYS LICENSED SPEECH-LANGUAGE PATHOGIST