Provider Demographics
NPI:1578827986
Name:MISTIC, JULIE CATHERINE (AUD)
Entity Type:Individual
Prefix:
First Name:JULIE
Middle Name:CATHERINE
Last Name:MISTIC
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 1:1600 W BUSINESS 380
Mailing Address - Street 2:SUITE A
Mailing Address - City:DECATUR
Mailing Address - State:TX
Mailing Address - Zip Code:76234-3270
Mailing Address - Country:US
Mailing Address - Phone:940-627-7997
Mailing Address - Fax:940-627-7416
Practice Address - Street 1:1600 W BUSINESS 380
Practice Address - Street 2:SUITE A
Practice Address - City:DECATUR
Practice Address - State:TX
Practice Address - Zip Code:76234-3270
Practice Address - Country:US
Practice Address - Phone:940-627-7997
Practice Address - Fax:940-627-7416
Is Sole Proprietor?:No
Enumeration Date:2012-06-29
Last Update Date:2016-12-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX80401231H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes231H00000XSpeech, Language and Hearing Service ProvidersAudiologist