Provider Demographics
NPI:1053087700
Name:GRUNER, JULIA LAURA (MS CCC-SLP)
Entity Type:Individual
Prefix:
First Name:JULIA
Middle Name:LAURA
Last Name:GRUNER
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 1:1097 NE SOCKEYE CT
Mailing Address - Street 2:
Mailing Address - City:BREMERTON
Mailing Address - State:WA
Mailing Address - Zip Code:98311-5000
Mailing Address - Country:US
Mailing Address - Phone:661-400-1864
Mailing Address - Fax:
Practice Address - Street 1:1097 NE SOCKEYE CT
Practice Address - Street 2:
Practice Address - City:BREMERTON
Practice Address - State:WA
Practice Address - Zip Code:98311-5000
Practice Address - Country:US
Practice Address - Phone:661-400-1864
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2021-08-20
Last Update Date:2021-08-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VALL60975441235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist