Provider Demographics
NPI:1972107449
Name:POLLOM, JUDY (SLP)
Entity Type:Individual
Prefix:
First Name:JUDY
Middle Name:
Last Name:POLLOM
Suffix:
Gender:F
Credentials:SLP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:8340 MALINEE OTT RD NE
Mailing Address - Street 2:
Mailing Address - City:GEORGETOWN
Mailing Address - State:IN
Mailing Address - Zip Code:47122-7512
Mailing Address - Country:US
Mailing Address - Phone:502-494-7995
Mailing Address - Fax:
Practice Address - Street 1:1101 LYNDON LN
Practice Address - Street 2:
Practice Address - City:LOUISVILLE
Practice Address - State:KY
Practice Address - Zip Code:40222-4317
Practice Address - Country:US
Practice Address - Phone:502-425-0331
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2020-11-25
Last Update Date:2020-11-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KY141491235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist