Provider Demographics
NPI:1285090290
Name:WASSERMANN, JUDITH (MS CC-SLP)
Entity type:Individual
Prefix:
First Name:JUDITH
Middle Name:
Last Name:WASSERMANN
Suffix:
Gender:F
Credentials:MS CC-SLP
Other - Prefix:
Other - First Name:JODY
Other - Middle Name:LYNN
Other - Last Name:MIELCASZ
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:MS, CCC-SLP
Mailing Address - Street 1:11100 COLOMA RD
Mailing Address - Street 2:
Mailing Address - City:RANCHO CORDOVA
Mailing Address - State:CA
Mailing Address - Zip Code:95670-2804
Mailing Address - Country:US
Mailing Address - Phone:916-361-7290
Mailing Address - Fax:916-361-8613
Practice Address - Street 1:11100 COLOMA RD
Practice Address - Street 2:
Practice Address - City:RANCHO CORDOVA
Practice Address - State:CA
Practice Address - Zip Code:95670-2804
Practice Address - Country:US
Practice Address - Phone:916-361-7290
Practice Address - Fax:916-361-8613
Is Sole Proprietor?:No
Enumeration Date:2016-01-06
Last Update Date:2016-01-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA8760235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist