Provider Demographics
NPI:1083129589
Name:MUNLEY, JULIE TENEYCK
Entity Type:Individual
Prefix:
First Name:JULIE
Middle Name:TENEYCK
Last Name:MUNLEY
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:142 MORNING GLORY CT
Mailing Address - Street 2:
Mailing Address - City:WINDSOR
Mailing Address - State:CT
Mailing Address - Zip Code:06095-4762
Mailing Address - Country:US
Mailing Address - Phone:860-205-5469
Mailing Address - Fax:
Practice Address - Street 1:142 MORNING GLORY CT
Practice Address - Street 2:
Practice Address - City:WINDSOR
Practice Address - State:CT
Practice Address - Zip Code:06095-4762
Practice Address - Country:US
Practice Address - Phone:860-205-5469
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2017-12-06
Last Update Date:2017-12-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CT002066235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist