Provider Demographics
NPI:1598300865
Name:SELBO, JULIA (MS, CCC-SLP)
Entity Type:Individual
Prefix:
First Name:JULIA
Middle Name:
Last Name:SELBO
Suffix:
Gender:F
Credentials:MS, CCC-SLP
Other - Prefix:
Other - First Name:JULIA
Other - Middle Name:
Other - Last Name:BERGMANN
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:2704 S 120TH PL
Mailing Address - Street 2:
Mailing Address - City:BURIEN
Mailing Address - State:WA
Mailing Address - Zip Code:98168-5153
Mailing Address - Country:US
Mailing Address - Phone:630-995-0214
Mailing Address - Fax:
Practice Address - Street 1:35535 6TH AVE SW
Practice Address - Street 2:
Practice Address - City:FEDERAL WAY
Practice Address - State:WA
Practice Address - Zip Code:98023-8110
Practice Address - Country:US
Practice Address - Phone:253-874-5445
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2019-11-11
Last Update Date:2019-11-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WA60967203235Z00000X
14335961235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist