Provider Demographics
NPI:1043490840
Name:KRUPP, JUDIE LEE (MACCC/SLP)
Entity type:Individual
Prefix:MRS
First Name:JUDIE
Middle Name:LEE
Last Name:KRUPP
Suffix:
Gender:F
Credentials:MACCC/SLP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:21607 HELMSDALE RUN
Mailing Address - Street 2:
Mailing Address - City:ESTERO
Mailing Address - State:FL
Mailing Address - Zip Code:33928-6242
Mailing Address - Country:US
Mailing Address - Phone:239-913-7454
Mailing Address - Fax:239-992-4518
Practice Address - Street 1:21607 HELMSDALE RUN
Practice Address - Street 2:
Practice Address - City:ESTERO
Practice Address - State:FL
Practice Address - Zip Code:33928-6242
Practice Address - Country:US
Practice Address - Phone:239-913-7454
Practice Address - Fax:239-992-4518
Is Sole Proprietor?:Yes
Enumeration Date:2007-11-08
Last Update Date:2007-11-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLSA4860235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist