Provider Demographics
NPI:1568440410
Name:HERNDON, JULIE ANNE (MS CCC/SLP)
Entity Type:Individual
Prefix:
First Name:JULIE
Middle Name:ANNE
Last Name:HERNDON
Suffix:
Gender:F
Credentials:MS CCC/SLP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6660 DELMONICO DR STE D
Mailing Address - Street 2:
Mailing Address - City:COLORADO SPRINGS
Mailing Address - State:CO
Mailing Address - Zip Code:80919-1961
Mailing Address - Country:US
Mailing Address - Phone:888-701-9216
Mailing Address - Fax:866-569-1087
Practice Address - Street 1:5850 MORNING LIGHT TER
Practice Address - Street 2:
Practice Address - City:COLORADO SPRINGS
Practice Address - State:CO
Practice Address - Zip Code:80919-3781
Practice Address - Country:US
Practice Address - Phone:719-651-9401
Practice Address - Fax:719-598-2644
Is Sole Proprietor?:No
Enumeration Date:2006-01-01
Last Update Date:2021-03-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CO01091128235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist
Provider Identifiers
StateIdentifier IDID TypeIssuer
CO39787001Medicaid