Provider Demographics
NPI:1104187731
Name:AMANN, JULIE (MS, CCC-SLP)
Entity Type:Individual
Prefix:
First Name:JULIE
Middle Name:
Last Name:AMANN
Suffix:
Gender:F
Credentials:MS, CCC-SLP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:130 PHEASANT RDG
Mailing Address - Street 2:
Mailing Address - City:THOMASVILLE
Mailing Address - State:GA
Mailing Address - Zip Code:31792-1660
Mailing Address - Country:US
Mailing Address - Phone:229-236-1005
Mailing Address - Fax:
Practice Address - Street 1:130 PHEASANT RDG
Practice Address - Street 2:
Practice Address - City:THOMASVILLE
Practice Address - State:GA
Practice Address - Zip Code:31792-1660
Practice Address - Country:US
Practice Address - Phone:850-545-8703
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2012-05-30
Last Update Date:2012-05-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLSA7778235Z00000X
GASLP006246235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist