Provider Demographics
NPI:1073582599
Name:PARKER, JULIE MARIE (AUD)
Entity Type:Individual
Prefix:
First Name:JULIE
Middle Name:MARIE
Last Name:PARKER
Suffix:
Gender:F
Credentials:AUD
Other - Prefix:
Other - First Name:JULIE
Other - Middle Name:MARIE
Other - Last Name:BENNETT
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:1 GUTHRIE SQ
Mailing Address - Street 2:
Mailing Address - City:SAYRE
Mailing Address - State:PA
Mailing Address - Zip Code:18840-1625
Mailing Address - Country:US
Mailing Address - Phone:570-888-5858
Mailing Address - Fax:
Practice Address - Street 1:3 GUTHRIE DR
Practice Address - Street 2:
Practice Address - City:CORNING
Practice Address - State:NY
Practice Address - Zip Code:14830-3696
Practice Address - Country:US
Practice Address - Phone:570-888-5858
Practice Address - Fax:570-887-2244
Is Sole Proprietor?:No
Enumeration Date:2006-03-16
Last Update Date:2021-03-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY001934-1231H00000X
PAAT005930231H00000X
NY001934231H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes231H00000XSpeech, Language and Hearing Service ProvidersAudiologist
Provider Identifiers
StateIdentifier IDID TypeIssuer
PAGU040061OtherMEDICARE GROUP
NYP00324439OtherRR MEDICARE PIN
NYCC8362OtherRR MEDICARE GROUP
PACC9269OtherRR MEDICARE GROUP
PAP00199348OtherRR MEDICARE PIN
NY0267642Medicaid
NYCC8362OtherRR MEDICARE GROUP
PA1011372280001Medicare ID - Type Unspecified
PAP00199348OtherRR MEDICARE PIN
NY0267642Medicaid