Provider Demographics
NPI:1982000139
Name:CLARK, JUDY A (HIS)
Entity Type:Individual
Prefix:MRS
First Name:JUDY
Middle Name:A
Last Name:CLARK
Suffix:
Gender:F
Credentials:HIS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:733 N. LOGAN #4
Mailing Address - Street 2:AUDIBEL HEARING AIDS
Mailing Address - City:DANVILLE
Mailing Address - State:IL
Mailing Address - Zip Code:61832
Mailing Address - Country:US
Mailing Address - Phone:217-442-1900
Mailing Address - Fax:217-442-1765
Practice Address - Street 1:1302 CHARLESTON AVENUE
Practice Address - Street 2:AUDIBEL HEARING AIDS
Practice Address - City:MATTOON
Practice Address - State:IL
Practice Address - Zip Code:61938
Practice Address - Country:US
Practice Address - Phone:217-235-5203
Practice Address - Fax:217-235-5210
Is Sole Proprietor?:No
Enumeration Date:2014-11-17
Last Update Date:2014-11-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL1952237700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes237700000XSpeech, Language and Hearing Service ProvidersHearing Instrument Specialist