Provider Demographics
NPI:1669893707
Name:MILGRAM, JUDITH ANNE (MS, SLP)
Entity type:Individual
Prefix:
First Name:JUDITH
Middle Name:ANNE
Last Name:MILGRAM
Suffix:
Gender:F
Credentials:MS, SLP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:328 ASHLEY DR
Mailing Address - Street 2:
Mailing Address - City:MARIETTA
Mailing Address - State:PA
Mailing Address - Zip Code:17547-9259
Mailing Address - Country:US
Mailing Address - Phone:818-599-2519
Mailing Address - Fax:
Practice Address - Street 1:900 E KING ST
Practice Address - Street 2:
Practice Address - City:LANCASTER
Practice Address - State:PA
Practice Address - Zip Code:17602-3272
Practice Address - Country:US
Practice Address - Phone:717-299-7877
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2013-12-16
Last Update Date:2014-08-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PASL012021235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist