Healthcare Provider Details

I. General information

NPI: 1457375503
Provider Name (Legal Business Name): JUDY LEONE HAYES M.ED.,COMS,CLVT
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/26/2006
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

619 S MARION AVE VIST 11/CA
LAKE CITY FL
32025-5808
US

IV. Provider business mailing address

174 SE ELM LOOP
LAKE CITY FL
32025-6470
US

V. Phone/Fax

Practice location:
  • Phone: 386-755-3016
  • Fax: 386-754-6423
Mailing address:
  • Phone: 386-752-7012
  • Fax: 386-754-6423

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2255R0406X
TaxonomyBlind Rehabilitation Specialist/Technologist
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: