Provider Demographics
NPI:1861794984
Name:JUDSON, MEGAN LOUISE
Entity type:Individual
Prefix:
First Name:MEGAN
Middle Name:LOUISE
Last Name:JUDSON
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2775 N. HWY. 360
Mailing Address - Street 2:#1224
Mailing Address - City:GRAND PRAIRIE
Mailing Address - State:TX
Mailing Address - Zip Code:75050
Mailing Address - Country:US
Mailing Address - Phone:414-943-5012
Mailing Address - Fax:
Practice Address - Street 1:6191 N STATE HIGHWAY 161
Practice Address - Street 2:SUITE 650
Practice Address - City:IRVING
Practice Address - State:TX
Practice Address - Zip Code:75038-2246
Practice Address - Country:US
Practice Address - Phone:972-812-3299
Practice Address - Fax:972-812-3283
Is Sole Proprietor?:Yes
Enumeration Date:2010-11-22
Last Update Date:2010-11-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX106293235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist