Provider Demographics
NPI:1770228223
Name:JUDY, ANNSLEY (MA, CCC-SLP)
Entity Type:Individual
Prefix:
First Name:ANNSLEY
Middle Name:
Last Name:JUDY
Suffix:
Gender:F
Credentials:MA, CCC-SLP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:134 AMBER DR
Mailing Address - Street 2:
Mailing Address - City:REEVESVILLE
Mailing Address - State:SC
Mailing Address - Zip Code:29471-4603
Mailing Address - Country:US
Mailing Address - Phone:843-200-6716
Mailing Address - Fax:
Practice Address - Street 1:134 AMBER DR
Practice Address - Street 2:
Practice Address - City:REEVESVILLE
Practice Address - State:SC
Practice Address - Zip Code:29471-4603
Practice Address - Country:US
Practice Address - Phone:843-200-6716
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2022-04-29
Last Update Date:2022-04-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SC7763235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist