Provider Demographics
NPI:1609242601
Name:BOGLE, JULIE LYNN (MED, CCC-SLP)
Entity Type:Individual
Prefix:MISS
First Name:JULIE
Middle Name:LYNN
Last Name:BOGLE
Suffix:
Gender:F
Credentials:MED, CCC-SLP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1467 CHESSINGTON CIR
Mailing Address - Street 2:
Mailing Address - City:LAKE MARY
Mailing Address - State:FL
Mailing Address - Zip Code:32746-1920
Mailing Address - Country:US
Mailing Address - Phone:615-585-7451
Mailing Address - Fax:
Practice Address - Street 1:1467 CHESSINGTON CIR
Practice Address - Street 2:
Practice Address - City:LAKE MARY
Practice Address - State:FL
Practice Address - Zip Code:32746-1920
Practice Address - Country:US
Practice Address - Phone:615-585-7451
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2015-08-13
Last Update Date:2020-06-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLSA15022235Z00000X
NY027755235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist