Healthcare Provider Details

I. General information

NPI: 1881185817
Provider Name (Legal Business Name): JENNIFER LYNN JUDAY MA, CCC-SLP
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/25/2018
Last Update Date: 04/27/2026
Certification Date: 04/27/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

501 SEQUOIA ST
MORRO BAY CA
93442-1453
US

IV. Provider business mailing address

1500 LIZZIE ST
SAN LUIS OBISPO CA
93401-3062
US

V. Phone/Fax

Practice location:
  • Phone: 805-771-1858
  • Fax:
Mailing address:
  • Phone: 805-503-0531
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code235Z00000X
TaxonomySpeech-Language Pathologist
License Number22339
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: