Provider Demographics
NPI:1720058738
Name:KYKER, JUDY MCINTYRE (CCC SLP)
Entity Type:Individual
Prefix:MRS
First Name:JUDY
Middle Name:MCINTYRE
Last Name:KYKER
Suffix:
Gender:F
Credentials:CCC SLP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6300 REGIONAL PLAZA
Mailing Address - Street 2:STE 850
Mailing Address - City:ABILENE
Mailing Address - State:TX
Mailing Address - Zip Code:79606
Mailing Address - Country:US
Mailing Address - Phone:325-698-9048
Mailing Address - Fax:325-698-9060
Practice Address - Street 1:6300 REGIONAL PLAZA
Practice Address - Street 2:STE 850
Practice Address - City:ABILENE
Practice Address - State:TX
Practice Address - Zip Code:79606
Practice Address - Country:US
Practice Address - Phone:325-698-9048
Practice Address - Fax:325-698-9060
Is Sole Proprietor?:Not Answered
Enumeration Date:2006-01-23
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX15667235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist
Provider Identifiers
StateIdentifier IDID TypeIssuer
87073TOtherBCBS TX
456594Medicare ID - Type Unspecified