Provider Demographics
NPI:1154616340
Name:JUDGE, MELISSA WATSON I (MS)
Entity type:Individual
Prefix:MRS
First Name:MELISSA
Middle Name:WATSON
Last Name:JUDGE
Suffix:I
Gender:F
Credentials:MS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2007 W MEADOW LN
Mailing Address - Street 2:
Mailing Address - City:CARBONDALE
Mailing Address - State:IL
Mailing Address - Zip Code:62901-2006
Mailing Address - Country:US
Mailing Address - Phone:618-559-8338
Mailing Address - Fax:
Practice Address - Street 1:2007 W MEADOW LN
Practice Address - Street 2:
Practice Address - City:CARBONDALE
Practice Address - State:IL
Practice Address - Zip Code:62901-2006
Practice Address - Country:US
Practice Address - Phone:618-559-8338
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2011-06-15
Last Update Date:2016-03-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL146.011191235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist