Provider Demographics
NPI:1518111491
Name:GOBLER, JULIE ANN (AUD, CCC-A)
Entity Type:Individual
Prefix:DR
First Name:JULIE
Middle Name:ANN
Last Name:GOBLER
Suffix:
Gender:F
Credentials:AUD, CCC-A
Other - Prefix:
Other - First Name:JULIE
Other - Middle Name:ANN
Other - Last Name:LARSON
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:MA, CCC-A
Mailing Address - Street 1:1305 CHESTNUT ST
Mailing Address - Street 2:
Mailing Address - City:WEST BEND
Mailing Address - State:WI
Mailing Address - Zip Code:53095-3060
Mailing Address - Country:US
Mailing Address - Phone:262-338-3553
Mailing Address - Fax:
Practice Address - Street 1:1305 CHESTNUT ST
Practice Address - Street 2:
Practice Address - City:WEST BEND
Practice Address - State:WI
Practice Address - Zip Code:53095-3060
Practice Address - Country:US
Practice Address - Phone:262-338-3553
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2008-11-05
Last Update Date:2014-09-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI242-156231H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes231H00000XSpeech, Language and Hearing Service ProvidersAudiologist
Provider Identifiers
StateIdentifier IDID TypeIssuer
WI41131100Medicaid