Provider Demographics
NPI:1093224255
Name:COTTER, JULIA EILEEN (PEL)
Entity Type:Individual
Prefix:
First Name:JULIA
Middle Name:EILEEN
Last Name:COTTER
Suffix:
Gender:F
Credentials:PEL
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:920 W CUSTER AVE
Mailing Address - Street 2:
Mailing Address - City:PONTIAC
Mailing Address - State:IL
Mailing Address - Zip Code:61764-1067
Mailing Address - Country:US
Mailing Address - Phone:815-844-7115
Mailing Address - Fax:815-848-7130
Practice Address - Street 1:920 W CUSTER AVE
Practice Address - Street 2:
Practice Address - City:PONTIAC
Practice Address - State:IL
Practice Address - Zip Code:61764-1067
Practice Address - Country:US
Practice Address - Phone:815-844-7115
Practice Address - Fax:815-848-7130
Is Sole Proprietor?:Yes
Enumeration Date:2017-09-20
Last Update Date:2022-07-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist
Provider Identifiers
StateIdentifier IDID TypeIssuer
IL90420OtherPEL