Provider Demographics
NPI:1851647317
Name:TATE, JUDITH A (MA)
Entity Type:Individual
Prefix:
First Name:JUDITH
Middle Name:A
Last Name:TATE
Suffix:
Gender:F
Credentials:MA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2000 HENDERSON RD
Mailing Address - Street 2:SUITE 10
Mailing Address - City:COLUMBUS
Mailing Address - State:OH
Mailing Address - Zip Code:43220-2453
Mailing Address - Country:US
Mailing Address - Phone:614-538-0472
Mailing Address - Fax:
Practice Address - Street 1:2000 HENDERSON RD
Practice Address - Street 2:SUITE 10
Practice Address - City:COLUMBUS
Practice Address - State:OH
Practice Address - Zip Code:43220-2453
Practice Address - Country:US
Practice Address - Phone:614-538-0472
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2012-08-01
Last Update Date:2012-08-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OHSP 2069235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist