Provider Demographics
NPI:1558427518
Name:BOSSENBERRY, JULIE (AUD)
Entity Type:Individual
Prefix:MS
First Name:JULIE
Middle Name:
Last Name:BOSSENBERRY
Suffix:
Gender:F
Credentials:AUD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:140 BROAD ST
Mailing Address - Street 2:
Mailing Address - City:MILFORD
Mailing Address - State:CT
Mailing Address - Zip Code:06460
Mailing Address - Country:US
Mailing Address - Phone:203-876-2266
Mailing Address - Fax:203-882-9640
Practice Address - Street 1:190 MAIN ST
Practice Address - Street 2:
Practice Address - City:EAST HAVEN
Practice Address - State:CT
Practice Address - Zip Code:06512
Practice Address - Country:US
Practice Address - Phone:203-466-3823
Practice Address - Fax:203-466-3823
Is Sole Proprietor?:No
Enumeration Date:2006-12-27
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CT000174237600000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes237600000XSpeech, Language and Hearing Service ProvidersAudiologist-Hearing Aid Fitter
Provider Identifiers
StateIdentifier IDID TypeIssuer
CT4093952Medicaid
CT0V0067OtherIT NET
CT730000174CT02OtherBCROSS