Provider Demographics
NPI:1609202688
Name:FRAZIER, JULIA MARIE (MS)
Entity Type:Individual
Prefix:
First Name:JULIA
Middle Name:MARIE
Last Name:FRAZIER
Suffix:
Gender:F
Credentials:MS
Other - Prefix:
Other - First Name:JULIA
Other - Middle Name:MARIE
Other - Last Name:KANDLIK
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:MS
Mailing Address - Street 1:5726 ELM ST
Mailing Address - Street 2:
Mailing Address - City:LISLE
Mailing Address - State:IL
Mailing Address - Zip Code:60532-2726
Mailing Address - Country:US
Mailing Address - Phone:630-390-8166
Mailing Address - Fax:
Practice Address - Street 1:830 S ADDISON AVE
Practice Address - Street 2:
Practice Address - City:VILLA PARK
Practice Address - State:IL
Practice Address - Zip Code:60181-2877
Practice Address - Country:US
Practice Address - Phone:630-620-4433
Practice Address - Fax:630-620-1148
Is Sole Proprietor?:No
Enumeration Date:2013-09-23
Last Update Date:2019-02-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL146.012334235Z00000X
IL242.002763235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist
Provider Identifiers
StateIdentifier IDID TypeIssuer
IL146.012334OtherSPEECH-LANGUAGE PATHOLOGIST LICENSE