Provider Demographics
NPI:1407332166
Name:GANGLOFF, JULIA MARIE (AUD)
Entity Type:Individual
Prefix:DR
First Name:JULIA
Middle Name:MARIE
Last Name:GANGLOFF
Suffix:
Gender:F
Credentials:AUD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:527 PLEASANT VIEW DR
Mailing Address - Street 2:
Mailing Address - City:LANCASTER
Mailing Address - State:NY
Mailing Address - Zip Code:14086-1403
Mailing Address - Country:US
Mailing Address - Phone:716-949-7600
Mailing Address - Fax:
Practice Address - Street 1:623 ATWELLS AVE
Practice Address - Street 2:
Practice Address - City:PROVIDENCE
Practice Address - State:RI
Practice Address - Zip Code:02909-7403
Practice Address - Country:US
Practice Address - Phone:401-455-4949
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2018-07-16
Last Update Date:2018-07-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA4744-SP-AU231H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes231H00000XSpeech, Language and Hearing Service ProvidersAudiologist