Provider Demographics
NPI:1164737946
Name:GLIESING, JULIE ALLISON
Entity Type:Individual
Prefix:
First Name:JULIE
Middle Name:ALLISON
Last Name:GLIESING
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:79 GREAT OAK LN
Mailing Address - Street 2:
Mailing Address - City:REDDING
Mailing Address - State:CT
Mailing Address - Zip Code:06896-1921
Mailing Address - Country:US
Mailing Address - Phone:203-733-1180
Mailing Address - Fax:
Practice Address - Street 1:79 GREAT OAK LN
Practice Address - Street 2:
Practice Address - City:REDDING
Practice Address - State:CT
Practice Address - Zip Code:06896-1921
Practice Address - Country:US
Practice Address - Phone:203-733-1180
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2010-08-17
Last Update Date:2010-08-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA2202006081235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist