Provider Demographics
NPI:1043486327
Name:SHORT, JULIE ANN (MA, CCC-SLP)
Entity Type:Individual
Prefix:MS
First Name:JULIE
Middle Name:ANN
Last Name:SHORT
Suffix:
Gender:F
Credentials:MA, CCC-SLP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:80 8TH AVE
Mailing Address - Street 2:SUITE 1301
Mailing Address - City:NEW YORK
Mailing Address - State:NY
Mailing Address - Zip Code:10011-5126
Mailing Address - Country:US
Mailing Address - Phone:212-929-3596
Mailing Address - Fax:
Practice Address - Street 1:80 8TH AVE
Practice Address - Street 2:SUITE 1301
Practice Address - City:NEW YORK
Practice Address - State:NY
Practice Address - Zip Code:10011-5126
Practice Address - Country:US
Practice Address - Phone:212-929-3596
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2008-05-06
Last Update Date:2008-05-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY003402235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist