Provider Demographics
NPI:1619256112
Name:DWYER, JULIE ELLYN (CCC-SLP)
Entity Type:Individual
Prefix:
First Name:JULIE
Middle Name:ELLYN
Last Name:DWYER
Suffix:
Gender:F
Credentials:CCC-SLP
Other - Prefix:
Other - First Name:JULIE
Other - Middle Name:ELLYN
Other - Last Name:CRESCAS
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:CCC-SLP
Mailing Address - Street 1:5 WOODBURY RD
Mailing Address - Street 2:
Mailing Address - City:FARMINGVILLE
Mailing Address - State:NY
Mailing Address - Zip Code:11738-2314
Mailing Address - Country:US
Mailing Address - Phone:914-441-0686
Mailing Address - Fax:631-846-8338
Practice Address - Street 1:5 WOODBURY RD
Practice Address - Street 2:
Practice Address - City:FARMINGVILLE
Practice Address - State:NY
Practice Address - Zip Code:11738-2314
Practice Address - Country:US
Practice Address - Phone:914-441-0686
Practice Address - Fax:631-846-8338
Is Sole Proprietor?:Yes
Enumeration Date:2011-08-15
Last Update Date:2011-08-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY012783-1235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist