Provider Demographics
NPI:1528234622
Name:JEFFREY, JUDY LYNN (MACCCSLP)
Entity type:Individual
Prefix:MRS
First Name:JUDY
Middle Name:LYNN
Last Name:JEFFREY
Suffix:
Gender:F
Credentials:MACCCSLP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:530 WEBB LOOP
Mailing Address - Street 2:
Mailing Address - City:MADISON
Mailing Address - State:NC
Mailing Address - Zip Code:27025-7954
Mailing Address - Country:US
Mailing Address - Phone:336-548-5379
Mailing Address - Fax:
Practice Address - Street 1:530 WEBB LOOP
Practice Address - Street 2:
Practice Address - City:MADISON
Practice Address - State:NC
Practice Address - Zip Code:27025-7954
Practice Address - Country:US
Practice Address - Phone:336-548-5379
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2008-05-08
Last Update Date:2008-05-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC2038235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist