Provider Demographics
NPI:1629416680
Name:TOBIN, JULIE MARIE (MS CCC-SLP)
Entity Type:Individual
Prefix:
First Name:JULIE
Middle Name:MARIE
Last Name:TOBIN
Suffix:
Gender:F
Credentials:MS CCC-SLP
Other - Prefix:
Other - First Name:JULIE
Other - Middle Name:MARIE
Other - Last Name:PASCHKE
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:M S CCC-SLP
Mailing Address - Street 1:201 N MONROE ST
Mailing Address - Street 2:
Mailing Address - City:CABOT
Mailing Address - State:AR
Mailing Address - Zip Code:72023-3563
Mailing Address - Country:US
Mailing Address - Phone:262-853-4509
Mailing Address - Fax:
Practice Address - Street 1:2400 W MARKHAM ST
Practice Address - Street 2:
Practice Address - City:LITTLE ROCK
Practice Address - State:AR
Practice Address - Zip Code:72205-6129
Practice Address - Country:US
Practice Address - Phone:501-324-9506
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2013-06-11
Last Update Date:2016-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC10491222Q00000X
AR235Z00000X
WI235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes222Q00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersDevelopmental Therapist
No235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist