Provider Demographics
NPI:1710408034
Name:MOOTZ, JULIANNA ROSE (MS CCC-SLP)
Entity Type:Individual
Prefix:MISS
First Name:JULIANNA
Middle Name:ROSE
Last Name:MOOTZ
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 1:1 STAYMAN CT APT I
Mailing Address - Street 2:
Mailing Address - City:CATONSVILLE
Mailing Address - State:MD
Mailing Address - Zip Code:21228-6031
Mailing Address - Country:US
Mailing Address - Phone:732-610-7156
Mailing Address - Fax:
Practice Address - Street 1:1277 GREEN HOLLY DR
Practice Address - Street 2:
Practice Address - City:ANNAPOLIS
Practice Address - State:MD
Practice Address - Zip Code:21409-4676
Practice Address - Country:US
Practice Address - Phone:410-974-4248
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2017-06-28
Last Update Date:2017-06-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MD08473235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist