Provider Demographics
NPI:1760750244
Name:HUDAK FERNANDES, JUDITH LYNNE (MS ED, CCC-SLP)
Entity Type:Individual
Prefix:MRS
First Name:JUDITH
Middle Name:LYNNE
Last Name:HUDAK FERNANDES
Suffix:
Gender:F
Credentials:MS ED, CCC-SLP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:454 FOLTS RD
Mailing Address - Street 2:
Mailing Address - City:HERKIMER
Mailing Address - State:NY
Mailing Address - Zip Code:13350-4006
Mailing Address - Country:US
Mailing Address - Phone:315-866-3766
Mailing Address - Fax:
Practice Address - Street 1:255 GROS BLVD
Practice Address - Street 2:
Practice Address - City:HERKIMER
Practice Address - State:NY
Practice Address - Zip Code:13350-1455
Practice Address - Country:US
Practice Address - Phone:315-866-8562
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2011-12-12
Last Update Date:2011-12-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY006420235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist