Provider Demographics
NPI:1669476404
Name:PELTZER, JULIE LAIL (MA, CCC-SLP)
Entity Type:Individual
Prefix:MRS
First Name:JULIE
Middle Name:LAIL
Last Name:PELTZER
Suffix:
Gender:F
Credentials:MA, CCC-SLP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1457 O'BRIAN DRIVE
Mailing Address - Street 2:
Mailing Address - City:NEWTON
Mailing Address - State:NC
Mailing Address - Zip Code:28658
Mailing Address - Country:US
Mailing Address - Phone:828-320-8787
Mailing Address - Fax:704-325-0831
Practice Address - Street 1:1457 O'BRIAN DRIVE
Practice Address - Street 2:
Practice Address - City:NEWTON
Practice Address - State:NC
Practice Address - Zip Code:28658
Practice Address - Country:US
Practice Address - Phone:828-320-8787
Practice Address - Fax:704-325-0831
Is Sole Proprietor?:No
Enumeration Date:2005-06-09
Last Update Date:2012-08-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC2975235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC7411048Medicaid