Provider Demographics
NPI:1689874232
Name:PENDLETON, JULIENE ANN (MSCCC-SLP)
Entity Type:Individual
Prefix:MRS
First Name:JULIENE
Middle Name:ANN
Last Name:PENDLETON
Suffix:
Gender:F
Credentials:MSCCC-SLP
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Other - Credentials:
Mailing Address - Street 1:OCCUPATIONAL AND SPEECH THERAPY SISTERS OF PROVIDENCE
Mailing Address - Street 2:3301 ST. MARY'S RD
Mailing Address - City:ST. MARY OF THE WOODS
Mailing Address - State:IN
Mailing Address - Zip Code:47876
Mailing Address - Country:US
Mailing Address - Phone:812-535-1095
Mailing Address - Fax:812-535-1004
Practice Address - Street 1:OCCUPATIONAL AND SPEECH THERAPY SISTERS OF PROVIDENCE
Practice Address - Street 2:3301 ST. MARY'S RD
Practice Address - City:ST. MARY OF THE WOODS
Practice Address - State:IN
Practice Address - Zip Code:47876
Practice Address - Country:US
Practice Address - Phone:812-535-1095
Practice Address - Fax:812-535-1004
Is Sole Proprietor?:No
Enumeration Date:2007-07-23
Last Update Date:2007-07-23
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
IN22001485A235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist