Provider Demographics
NPI:1255654760
Name:PURVIS, JULIE DIANE (SLP)
Entity Type:Individual
Prefix:
First Name:JULIE
Middle Name:DIANE
Last Name:PURVIS
Suffix:
Gender:F
Credentials:SLP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 4250
Mailing Address - Street 2:
Mailing Address - City:DES MOINES
Mailing Address - State:IA
Mailing Address - Zip Code:50333-4250
Mailing Address - Country:US
Mailing Address - Phone:515-243-2057
Mailing Address - Fax:515-244-5570
Practice Address - Street 1:604 LIBERTY ST
Practice Address - Street 2:SUITE 229
Practice Address - City:PELLA
Practice Address - State:IA
Practice Address - Zip Code:50219-1775
Practice Address - Country:US
Practice Address - Phone:641-621-1122
Practice Address - Fax:641-621-1177
Is Sole Proprietor?:No
Enumeration Date:2010-03-11
Last Update Date:2010-03-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IA002010235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist
Provider Identifiers
StateIdentifier IDID TypeIssuer
IA002010OtherLICENSE