Provider Demographics
NPI:1386177814
Name:WOOTTON, JUDY I (MA, CCC-SLP)
Entity type:Individual
Prefix:MS
First Name:JUDY
Middle Name:
Last Name:WOOTTON
Suffix:I
Gender:F
Credentials:MA, CCC-SLP
Other - Prefix:
Other - First Name:JUDITH
Other - Middle Name:LIGON
Other - Last Name:WOOTTON
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:
Mailing Address - Street 1:8260 ATLEE RD
Mailing Address - Street 2:
Mailing Address - City:MECHANICSVILLE
Mailing Address - State:VA
Mailing Address - Zip Code:23116-1844
Mailing Address - Country:US
Mailing Address - Phone:804-764-7634
Mailing Address - Fax:804-764-6211
Practice Address - Street 1:8260 ATLEE RD
Practice Address - Street 2:
Practice Address - City:MECHANICSVILLE
Practice Address - State:VA
Practice Address - Zip Code:23116-1844
Practice Address - Country:US
Practice Address - Phone:804-764-7634
Practice Address - Fax:804-764-6211
Is Sole Proprietor?:No
Enumeration Date:2017-04-11
Last Update Date:2017-04-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA2202001056235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist