Provider Demographics
NPI:1265508303
Name:BURGESS-DENNIS, JULIE (MS, CCC-SLP)
Entity Type:Individual
Prefix:MRS
First Name:JULIE
Middle Name:
Last Name:BURGESS-DENNIS
Suffix:
Gender:F
Credentials:MS, CCC-SLP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4230 198TH ST SW
Mailing Address - Street 2:
Mailing Address - City:LYNNWOOD
Mailing Address - State:WA
Mailing Address - Zip Code:98036-6762
Mailing Address - Country:US
Mailing Address - Phone:425-275-9071
Mailing Address - Fax:425-275-9045
Practice Address - Street 1:4230 198TH ST SW
Practice Address - Street 2:
Practice Address - City:LYNNWOOD
Practice Address - State:WA
Practice Address - Zip Code:98036-6762
Practice Address - Country:US
Practice Address - Phone:425-275-9071
Practice Address - Fax:425-275-9045
Is Sole Proprietor?:No
Enumeration Date:2006-11-28
Last Update Date:2007-07-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WALL00002918235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist
Provider Identifiers
StateIdentifier IDID TypeIssuer
WA7028319Medicaid
WA12011233OtherASHA NUMBER
WA7975166OtherAETNA INS. NUMBER
WA8412538Medicaid