Provider Demographics
NPI:1649722265
Name:DEEPE, JUDITH LEE (MSC,CCC-SLP)
Entity type:Individual
Prefix:MRS
First Name:JUDITH
Middle Name:LEE
Last Name:DEEPE
Suffix:
Gender:F
Credentials:MSC,CCC-SLP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:904 S COWAN AVE
Mailing Address - Street 2:
Mailing Address - City:YORK
Mailing Address - State:NE
Mailing Address - Zip Code:68467-4114
Mailing Address - Country:US
Mailing Address - Phone:402-362-2675
Mailing Address - Fax:
Practice Address - Street 1:1117 E SOUTH ST
Practice Address - Street 2:
Practice Address - City:HASTINGS
Practice Address - State:NE
Practice Address - Zip Code:68901-6443
Practice Address - Country:US
Practice Address - Phone:402-463-5611
Practice Address - Fax:402-463-9555
Is Sole Proprietor?:No
Enumeration Date:2016-10-31
Last Update Date:2016-10-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NE235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist