Provider Demographics
NPI:1326113655
Name:HAAS, JULIE MARIE (MA CCC-SLP)
Entity Type:Individual
Prefix:
First Name:JULIE
Middle Name:MARIE
Last Name:HAAS
Suffix:
Gender:F
Credentials:MA CCC-SLP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:61 W MAIN ST
Mailing Address - Street 2:
Mailing Address - City:NORTH EAST
Mailing Address - State:PA
Mailing Address - Zip Code:16428-1103
Mailing Address - Country:US
Mailing Address - Phone:814-725-4492
Mailing Address - Fax:814-725-4427
Practice Address - Street 1:61 W MAIN ST
Practice Address - Street 2:
Practice Address - City:NORTH EAST
Practice Address - State:PA
Practice Address - Zip Code:16428-1103
Practice Address - Country:US
Practice Address - Phone:814-725-4492
Practice Address - Fax:814-725-4427
Is Sole Proprietor?:Yes
Enumeration Date:2006-11-21
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PASL003241L235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA343290OtherHEALTH AMERICA
PA806646OtherHIGHMARK BC BS