Provider Demographics
NPI:1639683477
Name:MATHENEY, JULIE (MS, CCC-SLP, CLEC)
Entity Type:Individual
Prefix:
First Name:JULIE
Middle Name:
Last Name:MATHENEY
Suffix:
Gender:F
Credentials:MS, CCC-SLP, CLEC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1922 N LAS PALMAS AVE
Mailing Address - Street 2:
Mailing Address - City:LOS ANGELES
Mailing Address - State:CA
Mailing Address - Zip Code:90068-4101
Mailing Address - Country:US
Mailing Address - Phone:616-822-1812
Mailing Address - Fax:
Practice Address - Street 1:1922 N LAS PALMAS AVE
Practice Address - Street 2:
Practice Address - City:LOS ANGELES
Practice Address - State:CA
Practice Address - Zip Code:90068-4101
Practice Address - Country:US
Practice Address - Phone:616-822-1812
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2017-11-30
Last Update Date:2017-11-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA174N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes174N00000XOther Service ProvidersLactation Consultant, Non-RNGroup - Single Specialty