Provider Demographics
NPI:1346974979
Name:KIMBALL, JULIE (SLP)
Entity Type:Individual
Prefix:
First Name:JULIE
Middle Name:
Last Name:KIMBALL
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 1:1025 CREEKS EDGE VW
Mailing Address - Street 2:
Mailing Address - City:LEANDER
Mailing Address - State:TX
Mailing Address - Zip Code:78641-3981
Mailing Address - Country:US
Mailing Address - Phone:512-585-0410
Mailing Address - Fax:
Practice Address - Street 1:3800 N LAMAR BLVD STE 200
Practice Address - Street 2:
Practice Address - City:AUSTIN
Practice Address - State:TX
Practice Address - Zip Code:78756-0003
Practice Address - Country:US
Practice Address - Phone:512-585-0410
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2022-07-11
Last Update Date:2022-07-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX119824235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist