Provider Demographics
NPI:1851981823
Name:JUDD, LINDA LOU (LAC)
Entity Type:Individual
Prefix:
First Name:LINDA
Middle Name:LOU
Last Name:JUDD
Suffix:
Gender:F
Credentials:LAC
Other - Prefix:
Other - First Name:LINDA
Other - Middle Name:
Other - Last Name:JUDD
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:LAC
Mailing Address - Street 1:744 BRIARWOOD LN
Mailing Address - Street 2:
Mailing Address - City:HURST
Mailing Address - State:TX
Mailing Address - Zip Code:76053-5504
Mailing Address - Country:US
Mailing Address - Phone:817-714-4887
Mailing Address - Fax:
Practice Address - Street 1:1113 BEDFORD RD STE B
Practice Address - Street 2:
Practice Address - City:BEDFORD
Practice Address - State:TX
Practice Address - Zip Code:76022-6664
Practice Address - Country:US
Practice Address - Phone:817-312-1176
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2021-01-22
Last Update Date:2021-01-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX0541171100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171100000XOther Service ProvidersAcupuncturist