Provider Demographics
NPI:1669476180
Name:DENNIS, JUDY D (MS, CCC/SLP)
Entity Type:Individual
Prefix:
First Name:JUDY
Middle Name:D
Last Name:DENNIS
Suffix:
Gender:F
Credentials:MS, CCC/SLP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3424 HEMLOCK LN
Mailing Address - Street 2:
Mailing Address - City:OKLAHOMA CITY
Mailing Address - State:OK
Mailing Address - Zip Code:73120-5602
Mailing Address - Country:US
Mailing Address - Phone:405-755-3893
Mailing Address - Fax:405-755-3950
Practice Address - Street 1:3424 HEMLOCK LN
Practice Address - Street 2:
Practice Address - City:OKLAHOMA CITY
Practice Address - State:OK
Practice Address - Zip Code:73120-5602
Practice Address - Country:US
Practice Address - Phone:405-755-3893
Practice Address - Fax:405-755-3950
Is Sole Proprietor?:Yes
Enumeration Date:2005-06-13
Last Update Date:2007-07-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OK104235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist
Provider Identifiers
StateIdentifier IDID TypeIssuer
OK002518602999OtherBC/BS