Provider Demographics
NPI:1316218845
Name:KIRWAN, JULIA (CCC/SLP/L)
Entity Type:Individual
Prefix:MS
First Name:JULIA
Middle Name:
Last Name:KIRWAN
Suffix:
Gender:F
Credentials:CCC/SLP/L
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:327 W MASON ST
Mailing Address - Street 2:
Mailing Address - City:SPRINGFIELD
Mailing Address - State:IL
Mailing Address - Zip Code:62702-5019
Mailing Address - Country:US
Mailing Address - Phone:630-913-1140
Mailing Address - Fax:
Practice Address - Street 1:2601 MONTVALE DR
Practice Address - Street 2:
Practice Address - City:SPRINGFIELD
Practice Address - State:IL
Practice Address - Zip Code:62704-4200
Practice Address - Country:US
Practice Address - Phone:217-303-5803
Practice Address - Fax:217-303-5804
Is Sole Proprietor?:Yes
Enumeration Date:2012-01-13
Last Update Date:2016-07-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL146.002169235Z00000X
FLSA14611235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist