Basic Information
| Provider Information | |||||||||
| NPI: | 1982379921 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | JUDGE | ||||||||
| FirstName: | KATHERINE | ||||||||
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| Mailing Information | |||||||||
| Address1: | 17010 MAIN ST | ||||||||
| Address2: | |||||||||
| City: | WILDWOOD | ||||||||
| State: | MO | ||||||||
| PostalCode: | 630401237 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 3148527986 | ||||||||
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| Practice Location | |||||||||
| Address1: | 12110 CLAYTON RD | ||||||||
| Address2: | |||||||||
| City: | SAINT LOUIS | ||||||||
| State: | MO | ||||||||
| PostalCode: | 631312516 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 3149898100 | ||||||||
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| Other Information | |||||||||
| ProviderEnumerationDate: | 08/11/2021 | ||||||||
| LastUpdateDate: | 01/27/2022 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | N | ||||||||
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| NPICertificationDate: | 08/16/2021 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 235Z00000X | 2021024908 | MO | Y | Speech, Language and Hearing Service Providers | Speech-Language Pathologist |
ID Information
| ID | Type | State | Issuer | Description | 0 | 01 | NA | OTHER |