Provider Demographics
NPI:1881322865
Name:KINGMAN, JUDY BRENDING (MS SLP)
Entity type:Individual
Prefix:
First Name:JUDY
Middle Name:BRENDING
Last Name:KINGMAN
Suffix:
Gender:F
Credentials:MS SLP
Other - Prefix:
Other - First Name:JUDITH
Other - Middle Name:BRENDING
Other - Last Name:KINGMAN
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:
Mailing Address - Street 1:2805 LAREDO DR
Mailing Address - Street 2:
Mailing Address - City:FORT WORTH
Mailing Address - State:TX
Mailing Address - Zip Code:76116-3154
Mailing Address - Country:US
Mailing Address - Phone:817-815-6800
Mailing Address - Fax:
Practice Address - Street 1:2805 LAREDO DR
Practice Address - Street 2:
Practice Address - City:FORT WORTH
Practice Address - State:TX
Practice Address - Zip Code:76116-3154
Practice Address - Country:US
Practice Address - Phone:817-815-6800
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2022-08-09
Last Update Date:2022-08-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX163640235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist