Provider Demographics
NPI:1548401839
Name:JULIE A HERNDON, LLC
Entity Type:Organization
Organization Name:JULIE A HERNDON, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:SPEECH LANGUAGE PATHOLOGIST
Authorized Official - Prefix:
Authorized Official - First Name:JULIE
Authorized Official - Middle Name:A
Authorized Official - Last Name:HERNDON
Authorized Official - Suffix:
Authorized Official - Credentials:MS CCCSLP
Authorized Official - Phone:719-651-9401
Mailing Address - Street 1:540 BLACKHAWK CT
Mailing Address - Street 2:
Mailing Address - City:COLORADO SPRINGS
Mailing Address - State:CO
Mailing Address - Zip Code:80919-1143
Mailing Address - Country:US
Mailing Address - Phone:719-651-9401
Mailing Address - Fax:719-598-2644
Practice Address - Street 1:540 BLACKHAWK CT
Practice Address - Street 2:
Practice Address - City:COLORADO SPRINGS
Practice Address - State:CO
Practice Address - Zip Code:80919-1143
Practice Address - Country:US
Practice Address - Phone:719-651-9401
Practice Address - Fax:719-598-2644
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2009-03-16
Last Update Date:2009-10-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CO01091128235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language PathologistGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
CO71108700Medicaid