Provider Demographics
NPI:1629582689
Name:RICHARDS, JULIA RAE (MS,CCC-SLP/L)
Entity Type:Individual
Prefix:MRS
First Name:JULIA
Middle Name:RAE
Last Name:RICHARDS
Suffix:
Gender:F
Credentials:MS,CCC-SLP/L
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:711 E MCKINLEY RD
Mailing Address - Street 2:
Mailing Address - City:OTTAWA
Mailing Address - State:IL
Mailing Address - Zip Code:61350-4811
Mailing Address - Country:US
Mailing Address - Phone:815-433-3761
Mailing Address - Fax:815-433-9572
Practice Address - Street 1:711 E MCKINLEY RD
Practice Address - Street 2:
Practice Address - City:OTTAWA
Practice Address - State:IL
Practice Address - Zip Code:61350-4811
Practice Address - Country:US
Practice Address - Phone:815-433-3761
Practice Address - Fax:815-433-9572
Is Sole Proprietor?:Yes
Enumeration Date:2017-11-28
Last Update Date:2017-11-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL146001878235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist