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1174835375 NPI number — JUDITH D. METELUS CCC-SLP

NPI Number: 1174835375
Health Care Provider/Practitioner: JUDITH D. METELUS CCC-SLP

Information about “1174835375” NPI (JUDITH D. METELUS CCC-SLP) exists in 1174835375 in HTML format HTML  |  1174835375 in plain Text format TXT  |  1174835375 in PDF (Portable Document Format) PDF  |  1174835375 in an XML format XML  formats.

NPI Number : 1174835375 – JSON Data Format

                
{
  "Npi": {
    "NPI": "1174835375",
    "EntityType": "Individual",
    "ReplacementNPI": null,
    "EIN": null,
    "IsSoleProprietor": "N",
    "IsOrgSubpart": null,
    "ParentOrgLBN": null,
    "ParentOrgTIN": null,
    "OrgName": null,
    "LastName": "METELUS",
    "FirstName": "JUDITH",
    "MiddleName": "D.",
    "NamePrefix": "MRS.",
    "NameSuffix": null,
    "Credential": "CCC-SLP",
    "OtherOrgName": null,
    "OtherOrgNameTypeCode": null,
    "OtherLastName": "DESROSIERS",
    "OtherFirstName": "JUDITH",
    "OtherMiddleName": "L",
    "OtherNamePrefix": "MS.",
    "OtherNameSuffix": null,
    "OtherCredential": "CCC-SLP",
    "OtherLastNameTypeCode": "1",
    "FirstLineMailingAddress": "19 BAKER HILL RD",
    "SecondLineMailingAddress": "9",
    "MailingAddressCityName": "FREEVILLE",
    "MailingAddressStateName": "NY",
    "MailingAddressPostalCode": "13068-9623",
    "MailingAddressCountryCode": "US",
    "MailingAddressTelephoneNumber": null,
    "MailingAddressFaxNumber": null,
    "FirstLinePracticeLocationAddress": "19 BAKER HILL RD",
    "SecondLinePracticeLocationAddress": "9",
    "PracticeLocationAddressCityName": "FREEVILLE",
    "PracticeLocationAddressStateName": "NY",
    "PracticeLocationAddressPostalCode": "13068-9623",
    "PracticeLocationAddressCountryCode": "US",
    "PracticeLocationAddressTelephoneNumber": "607-319-4930",
    "PracticeLocationAddressFaxNumber": null,
    "EnumerationDate": "07/06/2010",
    "LastUpdateDate": "10/19/2010",
    "NPIDeactivationReasonCode": null,
    "NPIDeactivationReason": null,
    "NPIDeactivationDate": null,
    "NPIReactivationDate": null,
    "GenderCode": "F",
    "Gender": "Female",
    "AuthorizedOfficialLastName": null,
    "AuthorizedOfficialFirstName": null,
    "AuthorizedOfficialMiddleName": null,
    "AuthorizedOfficialTitle": null,
    "AuthorizedOfficialNamePrefix": null,
    "AuthorizedOfficialNameSuffix": null,
    "AuthorizedOfficialCredential": null,
    "AuthorizedOfficialTelephoneNumber": null,
    "Taxonomies": {
      "Taxonomy": {
        "TaxonomyCode": "235Z00000X",
        "TaxonomyName": "Speech-Language Pathologist",
        "LicenseNumber": "0198871",
        "LicenseNumberStateCode": "NY",
        "PrimaryTaxonomySwitch": "Y"
      }
    },
    "HealthcareProviderTaxonomyGroups": null
  }
}
                
            

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