Provider Demographics
NPI:1700092970
Name:ADAMS, JUDITH (AUD)
Entity Type:Individual
Prefix:DR
First Name:JUDITH
Middle Name:
Last Name:ADAMS
Suffix:
Gender:F
Credentials:AUD
Other - Prefix:
Other - First Name:JUDITH
Other - Middle Name:
Other - Last Name:ADAMS
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:AUD
Mailing Address - Street 1:PO BOX 406153
Mailing Address - Street 2:
Mailing Address - City:ATLANTA
Mailing Address - State:GA
Mailing Address - Zip Code:30384-1876
Mailing Address - Country:US
Mailing Address - Phone:561-478-8770
Mailing Address - Fax:561-598-7231
Practice Address - Street 1:3175 CHRISTY WAY S
Practice Address - Street 2:SUITE 4
Practice Address - City:SAGINAW
Practice Address - State:MI
Practice Address - Zip Code:48603-2210
Practice Address - Country:US
Practice Address - Phone:989-799-1611
Practice Address - Fax:989-799-1622
Is Sole Proprietor?:No
Enumeration Date:2007-05-15
Last Update Date:2011-09-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI1601000120237600000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes237600000XSpeech, Language and Hearing Service ProvidersAudiologist-Hearing Aid Fitter
Provider Identifiers
StateIdentifier IDID TypeIssuer
MI1700092970Medicaid
FLN71660030Medicare PIN