Provider Demographics
NPI:1023580289
Name:FERGUSON, JULIANNA (MCD, CF-SLP)
Entity Type:Individual
Prefix:
First Name:JULIANNA
Middle Name:
Last Name:FERGUSON
Suffix:
Gender:F
Credentials:MCD, CF-SLP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4712 W MELROSE AVE
Mailing Address - Street 2:
Mailing Address - City:TAMPA
Mailing Address - State:FL
Mailing Address - Zip Code:33629-5528
Mailing Address - Country:US
Mailing Address - Phone:813-389-5983
Mailing Address - Fax:
Practice Address - Street 1:4201 31ST ST S
Practice Address - Street 2:
Practice Address - City:ST PETERSBURG
Practice Address - State:FL
Practice Address - Zip Code:33712-4051
Practice Address - Country:US
Practice Address - Phone:727-867-1104
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2018-12-27
Last Update Date:2018-12-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLSZ8616235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist