Basic Information
| Provider Information | |||||||||
| NPI: | 1407004906 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | HIRSCH | ||||||||
| FirstName: | JUDITH | ||||||||
| MiddleName: | |||||||||
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| OtherLastName: | HIRSCH | ||||||||
| OtherFirstName: | JUDITH | ||||||||
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| OtherCredential: | M.A., CCC-A | ||||||||
| OtherLastNameType: | 2 | ||||||||
| Mailing Information | |||||||||
| Address1: | 572 SEGOVIA RD | ||||||||
| Address2: | |||||||||
| City: | ST AUGUSTINE | ||||||||
| State: | FL | ||||||||
| PostalCode: | 320866454 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 3405131926 | ||||||||
| FaxNumber: | |||||||||
| Practice Location | |||||||||
| Address1: | 9149 ESTATE THOMAS STE 308 | ||||||||
| Address2: | |||||||||
| City: | ST THOMAS | ||||||||
| State: | VI | ||||||||
| PostalCode: | 008023132 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 3407748881 | ||||||||
| FaxNumber: | 3407769807 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 09/09/2008 | ||||||||
| LastUpdateDate: | 11/09/2020 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | N | ||||||||
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| NPICertificationDate: | 11/09/2020 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 231HA2400X | N | Speech, Language and Hearing Service Providers | Audiologist | Assistive Technology Practitioner | 231HA2500X | N | Speech, Language and Hearing Service Providers | Audiologist | Assistive Technology Supplier | 237600000X | N | Speech, Language and Hearing Service Providers | Audiologist-Hearing Aid Fitter | 231H00000X | Y | Speech, Language and Hearing Service Providers | Audiologist |
No ID Information.