Provider Demographics
NPI:1114389848
Name:POE, JUDY
Entity type:Individual
Prefix:MRS
First Name:JUDY
Middle Name:
Last Name:POE
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1300 MEMORIAL DR
Mailing Address - Street 2:
Mailing Address - City:DENISON
Mailing Address - State:TX
Mailing Address - Zip Code:75020-2037
Mailing Address - Country:US
Mailing Address - Phone:903-327-8997
Mailing Address - Fax:
Practice Address - Street 1:1300 MEMORIAL DR
Practice Address - Street 2:
Practice Address - City:DENISON
Practice Address - State:TX
Practice Address - Zip Code:75020-2037
Practice Address - Country:US
Practice Address - Phone:903-327-8997
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2016-03-22
Last Update Date:2016-03-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX103206235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist