Provider Demographics
NPI:1689903072
Name:SKUBAL, JULIE ANN (MS, CCC-SLP)
Entity Type:Individual
Prefix:
First Name:JULIE
Middle Name:ANN
Last Name:SKUBAL
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 1:420 TAMARAC TRCE
Mailing Address - Street 2:
Mailing Address - City:PLATTEVILLE
Mailing Address - State:WI
Mailing Address - Zip Code:53818-1354
Mailing Address - Country:US
Mailing Address - Phone:608-642-7135
Mailing Address - Fax:608-348-2944
Practice Address - Street 1:1300 N WATER ST
Practice Address - Street 2:
Practice Address - City:PLATTEVILLE
Practice Address - State:WI
Practice Address - Zip Code:53818-1452
Practice Address - Country:US
Practice Address - Phone:608-348-2453
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2009-12-14
Last Update Date:2009-12-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI1116154235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist