Provider Demographics
NPI:1346552916
Name:ST. JULIAN-BALL, RENETTA MARCELLINA (SLP)
Entity Type:Individual
Prefix:MRS
First Name:RENETTA
Middle Name:MARCELLINA
Last Name:ST. JULIAN-BALL
Suffix:
Gender:F
Credentials:SLP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4201 DAPPLE GREY DR
Mailing Address - Street 2:
Mailing Address - City:RICHMOND
Mailing Address - State:VA
Mailing Address - Zip Code:23223-2284
Mailing Address - Country:US
Mailing Address - Phone:804-869-1677
Mailing Address - Fax:
Practice Address - Street 1:6318 BUNKER HILL DR
Practice Address - Street 2:
Practice Address - City:MECHANICSVILLE
Practice Address - State:VA
Practice Address - Zip Code:23111-4913
Practice Address - Country:US
Practice Address - Phone:804-869-1677
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2010-07-12
Last Update Date:2024-01-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA2202005827235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist