Provider Demographics
NPI:1255490033
Name:PETERS, JULIA A (MA, CCC-SLP)
Entity Type:Individual
Prefix:MS
First Name:JULIA
Middle Name:A
Last Name:PETERS
Suffix:
Gender:F
Credentials:MA, CCC-SLP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:546 HEMLOCK ST
Mailing Address - Street 2:
Mailing Address - City:JUNEAU
Mailing Address - State:AK
Mailing Address - Zip Code:99801-1435
Mailing Address - Country:US
Mailing Address - Phone:907-723-6305
Mailing Address - Fax:
Practice Address - Street 1:546 HEMLOCK ST
Practice Address - Street 2:
Practice Address - City:JUNEAU
Practice Address - State:AK
Practice Address - Zip Code:99801-1435
Practice Address - Country:US
Practice Address - Phone:907-723-6305
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-12-07
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AKSP0170235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist
Provider Identifiers
StateIdentifier IDID TypeIssuer
AKSP01701Medicaid
AKSP0170OtherSLP LICENSE #