Provider Demographics
NPI:1073654885
Name:DUNGAN, JULIA (MA, CCC, SLP)
Entity Type:Individual
Prefix:
First Name:JULIA
Middle Name:
Last Name:DUNGAN
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 1:1456 KINGSLEY DR
Mailing Address - Street 2:
Mailing Address - City:SHILOH
Mailing Address - State:IL
Mailing Address - Zip Code:62269-7253
Mailing Address - Country:US
Mailing Address - Phone:217-370-5624
Mailing Address - Fax:888-627-4177
Practice Address - Street 1:1456 KINGSLEY DR
Practice Address - Street 2:
Practice Address - City:SHILOH
Practice Address - State:IL
Practice Address - Zip Code:62269-7253
Practice Address - Country:US
Practice Address - Phone:217-370-5624
Practice Address - Fax:888-627-4177
Is Sole Proprietor?:No
Enumeration Date:2007-02-12
Last Update Date:2014-09-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AL2560235Z00000X
IL146.011319235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist
Provider Identifiers
StateIdentifier IDID TypeIssuer
AL582492069OtherTRICARE
AL51538180OtherBCBS
AL890018910Medicaid