Provider Demographics
NPI:1407123896
Name:SPOOR, JULIE DIANE (SLP)
Entity Type:Individual
Prefix:MRS
First Name:JULIE
Middle Name:DIANE
Last Name:SPOOR
Suffix:
Gender:F
Credentials:SLP
Other - Prefix:MRS
Other - First Name:JULIE
Other - Middle Name:DIANE
Other - Last Name:MIRAGLIA-SPOOR
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:SLP
Mailing Address - Street 1:229 REVERE DR
Mailing Address - Street 2:
Mailing Address - City:BALLSTON SPA
Mailing Address - State:NY
Mailing Address - Zip Code:12020-2320
Mailing Address - Country:US
Mailing Address - Phone:518-884-4009
Mailing Address - Fax:
Practice Address - Street 1:99 HUDSON ST
Practice Address - Street 2:
Practice Address - City:SOUTH GLENS FALLS
Practice Address - State:NY
Practice Address - Zip Code:12803-4944
Practice Address - Country:US
Practice Address - Phone:518-792-5891
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2011-11-29
Last Update Date:2011-11-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY006147235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist