Provider Demographics
NPI:1780931964
Name:DUNNAN, JUDITH R (SLP)
Entity type:Individual
Prefix:
First Name:JUDITH
Middle Name:R
Last Name:DUNNAN
Suffix:
Gender:F
Credentials:SLP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:593 EASTERN AVE
Mailing Address - Street 2:
Mailing Address - City:EAST HARDWICK
Mailing Address - State:VT
Mailing Address - Zip Code:05836-8913
Mailing Address - Country:US
Mailing Address - Phone:802-533-2243
Mailing Address - Fax:
Practice Address - Street 1:593 EASTERN AVE
Practice Address - Street 2:
Practice Address - City:EAST HARDWICK
Practice Address - State:VT
Practice Address - Zip Code:05836-8913
Practice Address - Country:US
Practice Address - Phone:802-533-2243
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2012-08-07
Last Update Date:2012-08-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VT235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist