Provider Demographics
NPI:1346584596
Name:BOLIN, JULIANNE C (MA CCC-SLP)
Entity Type:Individual
Prefix:
First Name:JULIANNE
Middle Name:C
Last Name:BOLIN
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 1:509 GROVE ST
Mailing Address - Street 2:
Mailing Address - City:WAKEFIELD
Mailing Address - State:KS
Mailing Address - Zip Code:67487-9159
Mailing Address - Country:US
Mailing Address - Phone:785-461-5471
Mailing Address - Fax:
Practice Address - Street 1:509 GROVE ST
Practice Address - Street 2:
Practice Address - City:WAKEFIELD
Practice Address - State:KS
Practice Address - Zip Code:67487-9159
Practice Address - Country:US
Practice Address - Phone:785-461-5471
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2012-11-11
Last Update Date:2012-11-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KS385235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist