Provider Demographics
NPI:1003066168
Name:REITZ, JULIA BRADEN (AUD)
Entity Type:Individual
Prefix:DR
First Name:JULIA
Middle Name:BRADEN
Last Name:REITZ
Suffix:
Gender:F
Credentials:AUD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:7920 OLD CEDAR AVE S
Mailing Address - Street 2:
Mailing Address - City:MINNEAPOLIS
Mailing Address - State:MN
Mailing Address - Zip Code:55425-1207
Mailing Address - Country:US
Mailing Address - Phone:952-428-1800
Mailing Address - Fax:
Practice Address - Street 1:7920 OLD CEDAR AVE S
Practice Address - Street 2:
Practice Address - City:BLOOMINGTON
Practice Address - State:MN
Practice Address - Zip Code:55425-1207
Practice Address - Country:US
Practice Address - Phone:952-428-1800
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2008-09-25
Last Update Date:2021-04-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WALD60061300237600000X
MN9664237600000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes237600000XSpeech, Language and Hearing Service ProvidersAudiologist-Hearing Aid Fitter
Provider Identifiers
StateIdentifier IDID TypeIssuer
WA8537714Medicaid
WAG8880003Medicare PIN
WA8537714Medicaid