Provider Demographics
NPI:1194951871
Name:HULLEY, JUDY (MS CCC-SLP)
Entity type:Individual
Prefix:
First Name:JUDY
Middle Name:
Last Name:HULLEY
Suffix:
Gender:F
Credentials:MS CCC-SLP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:330 S OCEAN TRACE RD
Mailing Address - Street 2:
Mailing Address - City:ST AUGUSTINE
Mailing Address - State:FL
Mailing Address - Zip Code:32080-6166
Mailing Address - Country:US
Mailing Address - Phone:904-315-6571
Mailing Address - Fax:
Practice Address - Street 1:4077 N CHINOOK LN
Practice Address - Street 2:
Practice Address - City:ORMOND BEACH
Practice Address - State:FL
Practice Address - Zip Code:32174-9326
Practice Address - Country:US
Practice Address - Phone:386-793-8120
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2009-06-08
Last Update Date:2009-06-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLSA4019235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist
Provider Identifiers
StateIdentifier IDID TypeIssuer
FLSA4019OtherSTATE LICENSE