1174835375 NPI number — MRS. JUDITH D. METELUS CCC-SLP

Table of content: MRS. JUDITH D. METELUS CCC-SLP (NPI 1174835375)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1174835375 NPI number — MRS. JUDITH D. METELUS CCC-SLP

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
METELUS
Provider First Name:
JUDITH
Provider Middle Name:
D.
Provider Name Prefix Text:
MRS.
Provider Name Suffix Text:
Provider Credential Text:
CCC-SLP
Provider Gender Code:
F

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
DESROSIERS
Provider Other First Name:
JUDITH
Provider Other Middle Name:
L
Provider Other Name Prefix Text:
MS.
Provider Other Name Suffix Text:
Provider Other Credential Text:
CCC-SLP
Provider Other Last Name Type Code:
1

NPI Number Information

NPI Number:
1174835375
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
10/19/2010
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
19 BAKER HILL RD
Provider Second Line Business Mailing Address:
9
Provider Business Mailing Address City Name:
FREEVILLE
Provider Business Mailing Address State Name:
NY
Provider Business Mailing Address Postal Code:
13068-9623
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
Provider Business Mailing Address Fax Number:

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
19 BAKER HILL RD
Provider Second Line Business Practice Location Address:
9
Provider Business Practice Location Address City Name:
FREEVILLE
Provider Business Practice Location Address State Name:
NY
Provider Business Practice Location Address Postal Code:
13068-9623
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
607-319-4930
Provider Business Practice Location Address Fax Number:
Provider Enumeration Date:
07/06/2010

Additional Information

Authorized Official

Authorized Official Last Name:
Authorized Official First Name:
Authorized Official Middle Name:
Authorized Official Title or Position:
Authorized Official Telephone Number:

Provider Taxonomy Codes

  • Taxonomy code: 235Z00000X , with the licence number:  0198871 , registered in the state of NY ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)





Copyright © 2007-2025 www.npivalidator.com