Provider Demographics
NPI:1619103009
Name:FJELDSTED, JULIA INGRID (MA CCC-SLP)
Entity Type:Individual
Prefix:
First Name:JULIA
Middle Name:INGRID
Last Name:FJELDSTED
Suffix:
Gender:F
Credentials:MA CCC-SLP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:820 CAMINO VISTAS ENCANTADA
Mailing Address - Street 2:
Mailing Address - City:SANTA FE
Mailing Address - State:NM
Mailing Address - Zip Code:87507-7797
Mailing Address - Country:US
Mailing Address - Phone:505-660-9781
Mailing Address - Fax:505-471-1403
Practice Address - Street 1:820 CAMINO VISTAS ENCANTADA
Practice Address - Street 2:
Practice Address - City:SANTA FE
Practice Address - State:NM
Practice Address - Zip Code:87507-7797
Practice Address - Country:US
Practice Address - Phone:505-660-9781
Practice Address - Fax:505-471-1403
Is Sole Proprietor?:No
Enumeration Date:2009-05-31
Last Update Date:2009-05-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NM1869235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist