Provider Demographics
NPI:1164547451
Name:JESMOND, JULIA (SLP)
Entity Type:Individual
Prefix:
First Name:JULIA
Middle Name:
Last Name:JESMOND
Suffix:
Gender:F
Credentials:SLP
Other - Prefix:
Other - First Name:JULIA
Other - Middle Name:
Other - Last Name:BAK
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:MA CCC-SLP
Mailing Address - Street 1:143 SONGBIRD LN
Mailing Address - Street 2:
Mailing Address - City:FARMINGTON
Mailing Address - State:CT
Mailing Address - Zip Code:06032-3433
Mailing Address - Country:US
Mailing Address - Phone:860-255-7887
Mailing Address - Fax:
Practice Address - Street 1:143 SONGBIRD LN
Practice Address - Street 2:
Practice Address - City:FARMINGTON
Practice Address - State:CT
Practice Address - Zip Code:06032-3433
Practice Address - Country:US
Practice Address - Phone:860-255-7887
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-03-19
Last Update Date:2010-08-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CT003697235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist
Provider Identifiers
StateIdentifier IDID TypeIssuer
CT660003697CT02Medicare UPIN
CT660003697CT01Medicare UPIN