Provider Demographics
NPI:1477299881
Name:CHUNG, JULIA LEE (CCC-SLP)
Entity Type:Individual
Prefix:
First Name:JULIA
Middle Name:LEE
Last Name:CHUNG
Suffix:
Gender:F
Credentials:CCC-SLP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:9950 W TROPICANA AVE APT 3011
Mailing Address - Street 2:
Mailing Address - City:LAS VEGAS
Mailing Address - State:NV
Mailing Address - Zip Code:89147-8549
Mailing Address - Country:US
Mailing Address - Phone:815-451-4167
Mailing Address - Fax:
Practice Address - Street 1:3101 W CHARLESTON BLVD
Practice Address - Street 2:
Practice Address - City:LAS VEGAS
Practice Address - State:NV
Practice Address - Zip Code:89102-1931
Practice Address - Country:US
Practice Address - Phone:702-831-6670
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2022-05-09
Last Update Date:2023-12-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NVSP-3182235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language PathologistGroup - Multi-Specialty