Provider Demographics
NPI:1003088949
Name:HAFNER, JULEE H (SA)
Entity Type:Individual
Prefix:MRS
First Name:JULEE
Middle Name:H
Last Name:HAFNER
Suffix:
Gender:F
Credentials:SA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2772 GALINDO CIR
Mailing Address - Street 2:
Mailing Address - City:MELBOURNE
Mailing Address - State:FL
Mailing Address - Zip Code:32940-5910
Mailing Address - Country:US
Mailing Address - Phone:321-720-7280
Mailing Address - Fax:321-306-2848
Practice Address - Street 1:3040 N WICKHAM RD STE 7
Practice Address - Street 2:
Practice Address - City:MELBOURNE
Practice Address - State:FL
Practice Address - Zip Code:32935-2369
Practice Address - Country:US
Practice Address - Phone:321-255-9546
Practice Address - Fax:321-255-4690
Is Sole Proprietor?:Yes
Enumeration Date:2008-04-01
Last Update Date:2020-09-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLSA9080235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist
Provider Identifiers
StateIdentifier IDID TypeIssuer
FLSA9080OtherPROFESSIONAL LICENSE