Provider Demographics
NPI:1124535851
Name:HALVERSON, JULIE DAWES (SLP-CCC, MA)
Entity Type:Individual
Prefix:
First Name:JULIE
Middle Name:DAWES
Last Name:HALVERSON
Suffix:
Gender:F
Credentials:SLP-CCC, MA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:404 OLD COUNTY RD
Mailing Address - Street 2:
Mailing Address - City:TEMPLETON
Mailing Address - State:CA
Mailing Address - Zip Code:93465-5074
Mailing Address - Country:US
Mailing Address - Phone:805-286-0425
Mailing Address - Fax:
Practice Address - Street 1:404 OLD COUNTY RD
Practice Address - Street 2:
Practice Address - City:TEMPLETON
Practice Address - State:CA
Practice Address - Zip Code:93465-5074
Practice Address - Country:US
Practice Address - Phone:805-286-0425
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2018-01-03
Last Update Date:2018-01-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA18426235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language PathologistGroup - Single Specialty