Provider Demographics
NPI:1679880199
Name:BURNETT, JULIA A (MS, CCC-SLP)
Entity Type:Individual
Prefix:
First Name:JULIA
Middle Name:A
Last Name:BURNETT
Suffix:
Gender:F
Credentials:MS, CCC-SLP
Other - Prefix:
Other - First Name:JULIA
Other - Middle Name:
Other - Last Name:BURNETT
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:MS, CCC-SLP
Mailing Address - Street 1:12492 KENTUCK RD
Mailing Address - Street 2:
Mailing Address - City:SUTHERLIN
Mailing Address - State:VA
Mailing Address - Zip Code:24594-3900
Mailing Address - Country:US
Mailing Address - Phone:276-733-5692
Mailing Address - Fax:
Practice Address - Street 1:12492 KENTUCK RD
Practice Address - Street 2:
Practice Address - City:SUTHERLIN
Practice Address - State:VA
Practice Address - Zip Code:24594-3900
Practice Address - Country:US
Practice Address - Phone:276-733-5692
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2010-09-03
Last Update Date:2023-11-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA2202006031235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist
Provider Identifiers
StateIdentifier IDID TypeIssuer
VA3001638088Medicaid