MEDICARE: NANCY S JUDGE ST

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	LL00004393	WA

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	2149JU	OTHER	WA	REGENCE BLUE SHIELD

General Provider Information

NPI Number	:	1992826390
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	NANCY S JUDGE ST

Provider Business Mailing Address
First Line	:	PO BOX 356
Second Line	:
City	:	OLYMPIA
State	:	WA
Zip	:	98507-0356
Country	:	US
Telephone Number	:	360-456-8281
Fax Number	:

Provider Business Practice Location Address
First Line	:	7026 41ST AVE SE
Second Line	:
City	:	OLYMPIA
State	:	WA
Zip	:	98503-4402
Country	:	US
Telephone Number	:	360-456-8281
Fax Number	:

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

Provider Enumeration Date	:	04/03/2007
Last Update Date	:	07/08/2007

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Directions to “ NANCY S JUDGE ST” Practice Location

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