Healthcare Provider Details

I. General information

NPI: 1033232335
Provider Name (Legal Business Name): JUDY H COLEMAN-WEBER AUDIOLOGIST
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 04/09/2007
Last Update Date: 03/15/2012
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4628 SUMMERHILL RD
TEXARKANA TX
75503-2742
US

IV. Provider business mailing address

4628 SUMMERHILL RD
TEXARKANA TX
75503-2742
US

V. Phone/Fax

Practice location:
  • Phone: 903-794-5839
  • Fax: 903-794-1686
Mailing address:
  • Phone: 903-794-5839
  • Fax: 903-794-1686

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code231H00000X
TaxonomyAudiologist
License Number50323
License Number StateTX
# 2
Primary TaxonomyN
Taxonomy Code231H00000X
TaxonomyAudiologist
License NumberA167
License Number StateAR
# 3
Primary TaxonomyY
Taxonomy Code237600000X
TaxonomyAudiologist-Hearing Aid Fitter
License Number90040
License Number StateTX

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: