Provider Demographics
NPI:1639688385
Name:COX, JUDY GILLIAM
Entity Type:Individual
Prefix:
First Name:JUDY
Middle Name:GILLIAM
Last Name:COX
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:305 NE LOOP 820
Mailing Address - Street 2:BUSSINES TOWER1 SUITE 200
Mailing Address - City:HURST
Mailing Address - State:TX
Mailing Address - Zip Code:76503
Mailing Address - Country:US
Mailing Address - Phone:817-292-8787
Mailing Address - Fax:817-789-6849
Practice Address - Street 1:110 CYPRESS STATION DR
Practice Address - Street 2:SUITE 270
Practice Address - City:HOUSTON
Practice Address - State:TX
Practice Address - Zip Code:77090
Practice Address - Country:US
Practice Address - Phone:832-378-6123
Practice Address - Fax:832-253-1181
Is Sole Proprietor?:Yes
Enumeration Date:2017-09-26
Last Update Date:2017-09-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX12639235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist