Provider Demographics
NPI:1033728340
Name:MEDLOCK, JULIA (MS, CCC-SLP)
Entity Type:Individual
Prefix:MRS
First Name:JULIA
Middle Name:
Last Name:MEDLOCK
Suffix:
Gender:F
Credentials:MS, CCC-SLP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:434 TURNER DR STE 1
Mailing Address - Street 2:
Mailing Address - City:DURANGO
Mailing Address - State:CO
Mailing Address - Zip Code:81303-3419
Mailing Address - Country:US
Mailing Address - Phone:941-518-0031
Mailing Address - Fax:
Practice Address - Street 1:434 TURNER DR STE 1
Practice Address - Street 2:
Practice Address - City:DURANGO
Practice Address - State:CO
Practice Address - Zip Code:81303-3419
Practice Address - Country:US
Practice Address - Phone:941-518-0031
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2020-07-23
Last Update Date:2024-01-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
235Z00000X
COSLP.0004198235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist