Provider Demographics
NPI:1245638501
Name:ANDERSON, JUDITH
Entity type:Individual
Prefix:
First Name:JUDITH
Middle Name:
Last Name:ANDERSON
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1311 BRANDYWINE BLVD
Mailing Address - Street 2:
Mailing Address - City:WILMINGTON
Mailing Address - State:DE
Mailing Address - Zip Code:19809-2306
Mailing Address - Country:US
Mailing Address - Phone:302-792-5072
Mailing Address - Fax:302-765-1996
Practice Address - Street 1:1311 BRANDYWINE BLVD
Practice Address - Street 2:
Practice Address - City:WILMINGTON
Practice Address - State:DE
Practice Address - Zip Code:19809-2306
Practice Address - Country:US
Practice Address - Phone:302-792-5072
Practice Address - Fax:302-765-1996
Is Sole Proprietor?:Yes
Enumeration Date:2014-12-18
Last Update Date:2014-12-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
DE01-0001190235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist