Provider Demographics
NPI:1629102397
Name:MEELIA, JULIE
Entity Type:Individual
Prefix:MRS
First Name:JULIE
Middle Name:
Last Name:MEELIA
Suffix:
Gender:F
Credentials:
Other - Prefix:MS
Other - First Name:JULIE
Other - Middle Name:
Other - Last Name:MARTIN
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:
Mailing Address - Street 1:15 CAMDEN LN
Mailing Address - Street 2:
Mailing Address - City:MANSFIELD
Mailing Address - State:MA
Mailing Address - Zip Code:02048-2680
Mailing Address - Country:US
Mailing Address - Phone:774-284-0011
Mailing Address - Fax:
Practice Address - Street 1:66 WEST ST
Practice Address - Street 2:SUITE 3
Practice Address - City:MANSFIELD
Practice Address - State:MA
Practice Address - Zip Code:02048-2404
Practice Address - Country:US
Practice Address - Phone:774-284-0011
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-03-15
Last Update Date:2014-06-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA6360235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist
Provider Identifiers
StateIdentifier IDID TypeIssuer
MA000000037236OtherBMC