Provider Demographics
NPI:1124347414
Name:BOERSMA, JUDY G (AUDIOLOGIST)
Entity type:Individual
Prefix:MS
First Name:JUDY
Middle Name:G
Last Name:BOERSMA
Suffix:
Gender:F
Credentials:AUDIOLOGIST
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:173 SCHAN DR
Mailing Address - Street 2:
Mailing Address - City:CHURCHVILLE
Mailing Address - State:PA
Mailing Address - Zip Code:18966-1619
Mailing Address - Country:US
Mailing Address - Phone:215-485-3205
Mailing Address - Fax:
Practice Address - Street 1:173 SCHAN DR
Practice Address - Street 2:
Practice Address - City:CHURCHVILLE
Practice Address - State:PA
Practice Address - Zip Code:18966-1619
Practice Address - Country:US
Practice Address - Phone:215-485-3205
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2010-05-26
Last Update Date:2010-05-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAAT000690L237600000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes237600000XSpeech, Language and Hearing Service ProvidersAudiologist-Hearing Aid Fitter
Provider Identifiers
StateIdentifier IDID TypeIssuer
PAAT000690LOtherPA AUDIOLOGY LICENSE
MO2009007983OtherMO AUDIOLOGY LICENSE
NJ41YA00072600OtherNJ AUDIOLOGY LICENSE