Provider Demographics
NPI:1649429606
Name:KROESE, JUDITH M (PHD)
Entity type:Individual
Prefix:
First Name:JUDITH
Middle Name:M
Last Name:KROESE
Suffix:
Gender:F
Credentials:PHD
Other - Prefix:
Other - First Name:JUDITH
Other - Middle Name:M
Other - Last Name:GEITH
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:1921 W HOSPITAL DR
Mailing Address - Street 2:
Mailing Address - City:TUCSON
Mailing Address - State:AZ
Mailing Address - Zip Code:85704-7806
Mailing Address - Country:US
Mailing Address - Phone:520-544-5237
Mailing Address - Fax:520-544-5333
Practice Address - Street 1:1921 W HOSPITAL DR
Practice Address - Street 2:
Practice Address - City:TUCSON
Practice Address - State:AZ
Practice Address - Zip Code:85704-7806
Practice Address - Country:US
Practice Address - Phone:520-544-5237
Practice Address - Fax:520-544-5333
Is Sole Proprietor?:No
Enumeration Date:2008-09-15
Last Update Date:2009-04-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZ3506103G00000X
AZSLP0527235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103G00000XBehavioral Health & Social Service ProvidersClinical Neuropsychologist
No235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist