Provider Demographics
NPI:1447386701
Name:BLAIR, JULIE (MNS CCC-SLP)
Entity Type:Individual
Prefix:MS
First Name:JULIE
Middle Name:
Last Name:BLAIR
Suffix:
Gender:F
Credentials:MNS CCC-SLP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1735 HILLSIDE DR
Mailing Address - Street 2:
Mailing Address - City:FORT COLLINS
Mailing Address - State:CO
Mailing Address - Zip Code:80524-1966
Mailing Address - Country:US
Mailing Address - Phone:970-420-5668
Mailing Address - Fax:
Practice Address - Street 1:1735 HILLSIDE DR
Practice Address - Street 2:
Practice Address - City:FORT COLLINS
Practice Address - State:CO
Practice Address - Zip Code:80524-1966
Practice Address - Country:US
Practice Address - Phone:970-420-5668
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-02-23
Last Update Date:2007-07-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist
Provider Identifiers
StateIdentifier IDID TypeIssuer
CO42979765Medicaid