Individual provider Active NPI

Monica Dawn Judy, M.S CCC-SLP

  • Speech-Language Pathologist
  • Broken Arrow, OK
National Provider Identifier
1508057498
Registry record updated Jan 7, 2010
On this page

Key facts

NPPES NPI Registry
Primary specialty
Speech-Language PathologistTaxonomy code 235Z00000X
License
3116 Issued in OK
Practice address
2208 W Detroit St Ste 101
Broken Arrow, OK 74012-3630
Phone
(918) 806-0106
Fax
(918) 806-0113
NPI assigned
Aug 6, 2007
Sex
Female
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Jan 7, 2010

Registry information is reported by the provider to CMS and is not verified. About this source

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Speech-Language Pathologist 235Z00000X 3116 OK Primary

Addresses

Primary practice location

2208 W Detroit St Ste 101
Broken Arrow, OK 74012-3630

Mailing address

24935 Ky Ave
Claremore, OK 74019-4348
Phone (918) 706-4140

Other identifiers 1

IdentifierTypeStateIssuer
200049340AMedicaidOK

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
Credentials
Master of Science

NPI Registry JSON

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1186358400000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1262822400000",
    "number": "1508057498",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "24935 KY AVE",
            "city": "CLAREMORE",
            "state": "OK",
            "postal_code": "740194348",
            "telephone_number": "918-706-4140",
            "fax_number": "918-343-9469"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "2208 W DETROIT ST STE 101",
            "city": "BROKEN ARROW",
            "state": "OK",
            "postal_code": "740123630",
            "telephone_number": "918-806-0106",
            "fax_number": "918-806-0113"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "JUDY",
        "first_name": "MONICA",
        "middle_name": "DAWN",
        "credential": "M.S CCC-SLP",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2007-08-06",
        "last_updated": "2010-01-07",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "235Z00000X",
            "taxonomy_group": "",
            "desc": "Speech-Language Pathologist",
            "state": "OK",
            "license": "3116",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "200049340A",
            "state": "OK"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Broken Arrow, OK

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jan 7, 2010; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
  • National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.