Provider Demographics
NPI:1285899716
Name:SPENCER, JUDITH K (SLP)
Entity type:Individual
Prefix:MRS
First Name:JUDITH
Middle Name:K
Last Name:SPENCER
Suffix:
Gender:F
Credentials:SLP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2003 TRACE 20
Mailing Address - Street 2:
Mailing Address - City:WEST LAFAYETTE
Mailing Address - State:IN
Mailing Address - Zip Code:47906-1885
Mailing Address - Country:US
Mailing Address - Phone:765-497-0540
Mailing Address - Fax:
Practice Address - Street 1:300 WINDY HILL DR
Practice Address - Street 2:
Practice Address - City:LAFAYETTE
Practice Address - State:IN
Practice Address - Zip Code:47905-2862
Practice Address - Country:US
Practice Address - Phone:765-477-7791
Practice Address - Fax:765-474-2986
Is Sole Proprietor?:No
Enumeration Date:2008-07-24
Last Update Date:2008-07-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN22004390A235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist