Provider Demographics
NPI:1275986820
Name:PETERSON, JULIA (MS, CFY-SLP)
Entity Type:Individual
Prefix:
First Name:JULIA
Middle Name:
Last Name:PETERSON
Suffix:
Gender:F
Credentials:MS, CFY-SLP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:117 CARLISLE WAY
Mailing Address - Street 2:
Mailing Address - City:SEBASTIAN
Mailing Address - State:FL
Mailing Address - Zip Code:32958-6488
Mailing Address - Country:US
Mailing Address - Phone:786-468-3845
Mailing Address - Fax:
Practice Address - Street 1:2050 40TH AVE STE 1
Practice Address - Street 2:
Practice Address - City:VERO BEACH
Practice Address - State:FL
Practice Address - Zip Code:32960-2467
Practice Address - Country:US
Practice Address - Phone:772-567-0061
Practice Address - Fax:772-567-0062
Is Sole Proprietor?:Yes
Enumeration Date:2016-07-19
Last Update Date:2016-07-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLSZ7655235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist