Provider Demographics
NPI:1497980106
Name:MARTIN, JULIE
Entity Type:Individual
Prefix:
First Name:JULIE
Middle Name:
Last Name:MARTIN
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:JULIET
Other - Middle Name:
Other - Last Name:BURKE
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:
Mailing Address - Street 1:3611 INDIAN HEAD LN
Mailing Address - Street 2:
Mailing Address - City:JOLIET
Mailing Address - State:IL
Mailing Address - Zip Code:60435-1590
Mailing Address - Country:US
Mailing Address - Phone:815-603-8632
Mailing Address - Fax:
Practice Address - Street 1:16W361 S FRONTAGE RD
Practice Address - Street 2:STE 131
Practice Address - City:BURR RIDGE
Practice Address - State:IL
Practice Address - Zip Code:60527-5830
Practice Address - Country:US
Practice Address - Phone:630-590-5571
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2009-05-26
Last Update Date:2010-11-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL146008544235Z00000X
103K00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist
No103K00000XBehavioral Health & Social Service ProvidersBehavior Analyst