Provider Demographics
NPI:1356486203
Name:BARCELOS, JULIE M (MS CCC SLP)
Entity Type:Individual
Prefix:MS
First Name:JULIE
Middle Name:M
Last Name:BARCELOS
Suffix:
Gender:F
Credentials:MS CCC SLP
Other - Prefix:MS
Other - First Name:JULIE
Other - Middle Name:M
Other - Last Name:PHENIX
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:MS CCC SLP
Mailing Address - Street 1:49 STATE ROAD
Mailing Address - Street 2:WATUPPA BLDG SUITE 105
Mailing Address - City:NORTH DARTMOUTH
Mailing Address - State:MA
Mailing Address - Zip Code:02747
Mailing Address - Country:US
Mailing Address - Phone:508-985-1996
Mailing Address - Fax:508-985-0067
Practice Address - Street 1:49 STATE ROAD
Practice Address - Street 2:WATUPPA BLDG SUITE 105
Practice Address - City:NORTH DARTMOUTH
Practice Address - State:MA
Practice Address - Zip Code:02747
Practice Address - Country:US
Practice Address - Phone:508-985-1996
Practice Address - Fax:508-985-0067
Is Sole Proprietor?:No
Enumeration Date:2007-02-20
Last Update Date:2016-05-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA4196235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist