Provider Demographics
NPI:1093830259
Name:LASHBROOK, JULIE SULLIVAN (CCC-SLP)
Entity Type:Individual
Prefix:MRS
First Name:JULIE
Middle Name:SULLIVAN
Last Name:LASHBROOK
Suffix:
Gender:F
Credentials:CCC-SLP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5143 MAXON TER
Mailing Address - Street 2:
Mailing Address - City:SANFORD
Mailing Address - State:FL
Mailing Address - Zip Code:32771-5439
Mailing Address - Country:US
Mailing Address - Phone:407-549-7876
Mailing Address - Fax:
Practice Address - Street 1:5143 MAXON TER
Practice Address - Street 2:
Practice Address - City:SANFORD
Practice Address - State:FL
Practice Address - Zip Code:32771-5439
Practice Address - Country:US
Practice Address - Phone:407-549-7876
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-03-20
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLSA5928235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist