Provider Demographics
NPI:1679647259
Name:GODFREY, JUDY K (MS CCCSLP)
Entity Type:Individual
Prefix:MRS
First Name:JUDY
Middle Name:K
Last Name:GODFREY
Suffix:
Gender:F
Credentials:MS CCCSLP
Other - Prefix:
Other - First Name:JUDY
Other - Middle Name:MAE
Other - Last Name:GODFREY
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:
Mailing Address - Street 1:493 EAST 5600 SOUTH
Mailing Address - Street 2:
Mailing Address - City:MURRAY
Mailing Address - State:UT
Mailing Address - Zip Code:84107-6261
Mailing Address - Country:US
Mailing Address - Phone:801-262-7998
Mailing Address - Fax:
Practice Address - Street 1:3855 S 700 E
Practice Address - Street 2:WOODLAND PARK CARE CENTER
Practice Address - City:SALT LAKE CITY
Practice Address - State:UT
Practice Address - Zip Code:84106
Practice Address - Country:US
Practice Address - Phone:801-270-2531
Practice Address - Fax:801-281-9743
Is Sole Proprietor?:No
Enumeration Date:2006-11-17
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
UT355200-4102235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist
Provider Identifiers
StateIdentifier IDID TypeIssuer
UT09130770OtherASHA
UTD2289Medicaid