Provider Demographics
NPI:1679609325
Name:VACHALEK, JULIE MOLITOR (MS, CCC-SLP)
Entity Type:Individual
Prefix:
First Name:JULIE
Middle Name:MOLITOR
Last Name:VACHALEK
Suffix:
Gender:F
Credentials:MS, CCC-SLP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:284 MERCHANT ST
Mailing Address - Street 2:
Mailing Address - City:STE GENEVIEVE
Mailing Address - State:MO
Mailing Address - Zip Code:63670-1610
Mailing Address - Country:US
Mailing Address - Phone:314-680-9700
Mailing Address - Fax:314-962-5875
Practice Address - Street 1:13 CLYDEHURST DR
Practice Address - Street 2:
Practice Address - City:WEBSTER GROVES
Practice Address - State:MO
Practice Address - Zip Code:63119-2011
Practice Address - Country:US
Practice Address - Phone:314-680-9700
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-02-26
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MO2001003676235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist