Provider Demographics
NPI:1770768830
Name:BRUSH, JUDITH PAMELA
Entity type:Individual
Prefix:MRS
First Name:JUDITH
Middle Name:PAMELA
Last Name:BRUSH
Suffix:
Gender:F
Credentials:
Other - Prefix:MS
Other - First Name:JUDITH
Other - Middle Name:PAMELA
Other - Last Name:ADKINS
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:44 LACOSTA BLVD
Mailing Address - Street 2:
Mailing Address - City:MARTINSBURG
Mailing Address - State:WV
Mailing Address - Zip Code:25405-6189
Mailing Address - Country:US
Mailing Address - Phone:304-267-2738
Mailing Address - Fax:
Practice Address - Street 1:JEFFERSON COUNTY BOARD OF EDUCATION
Practice Address - Street 2:110 MORDINGTON AVE.
Practice Address - City:CHARLES TOWN
Practice Address - State:WV
Practice Address - Zip Code:25414
Practice Address - Country:US
Practice Address - Phone:304-725-9741
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2008-01-08
Last Update Date:2008-01-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WV235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist