MEDICARE: JUDITH WALTON MSP, CCC-SLP

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	235Z00000X	Speech-Language Pathologist	00679	MO

General Provider Information

NPI Number	:	1699176628
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	JUDITH WALTON MSP, CCC-SLP

Provider Business Mailing Address
First Line	:	353 CONCORD LN
Second Line	:
City	:	JACKSON
State	:	MO
Zip	:	63755-7135
Country	:	US
Telephone Number	:	573-243-6543
Fax Number	:

Provider Business Practice Location Address
First Line	:	353 CONCORD LN
Second Line	:
City	:	JACKSON
State	:	MO
Zip	:	63755-7135
Country	:	US
Telephone Number	:	573-243-6543
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	09/09/2014
Last Update Date	:	09/09/2014

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