Provider Demographics
NPI:1265658108
Name:WIRTH, JULIE A (AUDIOLOGIST)
Entity Type:Individual
Prefix:MS
First Name:JULIE
Middle Name:A
Last Name:WIRTH
Suffix:
Gender:F
Credentials:AUDIOLOGIST
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:611 WEST PARK ST.
Mailing Address - Street 2:FAPC
Mailing Address - City:URBANA
Mailing Address - State:IL
Mailing Address - Zip Code:61801
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:611 W PARK ST
Practice Address - Street 2:
Practice Address - City:URBANA
Practice Address - State:IL
Practice Address - Zip Code:61801-2500
Practice Address - Country:US
Practice Address - Phone:217-383-4375
Practice Address - Fax:217-326-2336
Is Sole Proprietor?:No
Enumeration Date:2007-04-18
Last Update Date:2024-02-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL147000912231H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes231H00000XSpeech, Language and Hearing Service ProvidersAudiologist
Provider Identifiers
StateIdentifier IDID TypeIssuer
IL203OtherBLUE CROSS PROV ID
113326OtherHEALTHLINK PROV ID
IL4117OtherHAMP PROVIDER ID
IL371119538401Medicaid
7216OtherPERSONALCARE PROV ID
IL203OtherBLUE CROSS PROV ID