Active NPI
Judith Marie Gullaksen, M.S.-CCC-SLP
- Speech-Language Pathologist
- Frisco, TX
National Provider Identifier
1144501297
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Speech-Language Pathologist
- License
- 16611
- Practice address
- 2990 Legacy Dr
Frisco, TX 75034-6066 - Phone
- (469) 888-5100
- NPI assigned
- Sep 2, 2011
- Sex
- Female
- Sole proprietor
- No
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 1
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Speech-Language Pathologist | 235Z00000X | 16611 | TX | Primary |
Addresses
Primary practice location
2990 Legacy Dr
Frisco, TX 75034-6066
Mailing address
3067 Pack Saddle Way
Frisco, TX 75034-0768
Phone (214) 705-9686
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Not enrolled
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 16611 | TX | MD | General Practice Dentistry |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1314921600000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1314921600000",
"number": "1144501297",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "3067 PACK SADDLE WAY",
"city": "FRISCO",
"state": "TX",
"postal_code": "750340768",
"telephone_number": "214-705-9686"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "2990 LEGACY DR",
"city": "FRISCO",
"state": "TX",
"postal_code": "750346066",
"telephone_number": "469-888-5100"
}
],
"practiceLocations": [],
"basic": {
"last_name": "GULLAKSEN",
"first_name": "JUDITH",
"middle_name": "MARIE",
"name_prefix": "Mrs.",
"credential": "M.S.-CCC-SLP",
"sole_proprietor": "NO",
"sex": "F",
"enumeration_date": "2011-09-02",
"last_updated": "2011-09-02",
"status": "A"
},
"taxonomies": [
{
"code": "235Z00000X",
"taxonomy_group": "",
"desc": "Speech-Language Pathologist",
"state": "TX",
"license": "16611",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Frisco, TX
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Sep 2, 2011; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.