Provider Demographics
NPI:1235509258
Name:MCCORMACK, JULIA KEMPKA (SLP)
Entity Type:Individual
Prefix:
First Name:JULIA
Middle Name:KEMPKA
Last Name:MCCORMACK
Suffix:
Gender:F
Credentials:SLP
Other - Prefix:
Other - First Name:JULIA
Other - Middle Name:
Other - Last Name:KEMPKA
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:SLP
Mailing Address - Street 1:965 RIDGE LAKE BLVD STE 315
Mailing Address - Street 2:
Mailing Address - City:MEMPHIS
Mailing Address - State:TN
Mailing Address - Zip Code:38120-9401
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:901-227-8591
Practice Address - Street 1:2100 EXETER RD
Practice Address - Street 2:
Practice Address - City:GERMANTOWN
Practice Address - State:TN
Practice Address - Zip Code:38138-3966
Practice Address - Country:US
Practice Address - Phone:901-757-1350
Practice Address - Fax:901-757-3496
Is Sole Proprietor?:No
Enumeration Date:2015-10-02
Last Update Date:2021-10-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TN5691235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist