Provider Demographics
NPI:1538456868
Name:JOLLON, JULIE M (MA)
Entity Type:Individual
Prefix:
First Name:JULIE
Middle Name:M
Last Name:JOLLON
Suffix:
Gender:F
Credentials:MA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1101 JEROME ST
Mailing Address - Street 2:
Mailing Address - City:SEAFORD
Mailing Address - State:NY
Mailing Address - Zip Code:11783-1411
Mailing Address - Country:US
Mailing Address - Phone:516-661-2062
Mailing Address - Fax:
Practice Address - Street 1:1101 JEROME ST
Practice Address - Street 2:
Practice Address - City:SEAFORD
Practice Address - State:NY
Practice Address - Zip Code:11783-1411
Practice Address - Country:US
Practice Address - Phone:516-661-2062
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2011-07-07
Last Update Date:2015-11-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY021107-1235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist