Provider Demographics
NPI:1568995967
Name:SMITH, JULIE MICHELLE (MS, CCC-SLP)
Entity Type:Individual
Prefix:MS
First Name:JULIE
Middle Name:MICHELLE
Last Name:SMITH
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 1:530 S 34TH ST
Mailing Address - Street 2:
Mailing Address - City:MUSKOGEE
Mailing Address - State:OK
Mailing Address - Zip Code:74401-5038
Mailing Address - Country:US
Mailing Address - Phone:918-683-0321
Mailing Address - Fax:918-682-4574
Practice Address - Street 1:530 S 34TH ST
Practice Address - Street 2:
Practice Address - City:MUSKOGEE
Practice Address - State:OK
Practice Address - Zip Code:74401-5038
Practice Address - Country:US
Practice Address - Phone:918-683-0321
Practice Address - Fax:918-682-4574
Is Sole Proprietor?:No
Enumeration Date:2017-04-04
Last Update Date:2017-04-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OK2705235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist