Healthcare Provider Details

I. General information

NPI: 1194951871
Provider Name (Legal Business Name): JUDY HULLEY MS CCC-SLP
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 06/08/2009
Last Update Date: 06/08/2009
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4077 N CHINOOK LN
ORMOND BEACH FL
32174-9326
US

IV. Provider business mailing address

330 S OCEAN TRACE RD
ST AUGUSTINE FL
32080-6166
US

V. Phone/Fax

Practice location:
  • Phone: 386-793-8120
  • Fax:
Mailing address:
  • Phone: 904-315-6571
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code235Z00000X
TaxonomySpeech-Language Pathologist
License NumberSA4019
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: