Provider Demographics
NPI:1528108602
Name:LUDWIG-KELLER, JUDITH (SLP)
Entity type:Individual
Prefix:
First Name:JUDITH
Middle Name:
Last Name:LUDWIG-KELLER
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 1:11799 STATE HIGHWAY 337
Mailing Address - Street 2:ROOSEVELT MS
Mailing Address - City:TIJERAS
Mailing Address - State:NM
Mailing Address - Zip Code:87059-8619
Mailing Address - Country:US
Mailing Address - Phone:505-281-3316
Mailing Address - Fax:
Practice Address - Street 1:11799 STATE HIGHWAY 337
Practice Address - Street 2:ROOSEVELT MS
Practice Address - City:TIJERAS
Practice Address - State:NM
Practice Address - Zip Code:87059-8619
Practice Address - Country:US
Practice Address - Phone:505-281-3316
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-02-07
Last Update Date:2007-07-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NM2081235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist
Provider Identifiers
StateIdentifier IDID TypeIssuer
NML 4769Medicaid