Provider Demographics
NPI:1710453857
Name:WILSON, JULIA MARIE (SLPA)
Entity Type:Individual
Prefix:
First Name:JULIA
Middle Name:MARIE
Last Name:WILSON
Suffix:
Gender:F
Credentials:SLPA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4908 S CHARGER
Mailing Address - Street 2:
Mailing Address - City:MESA
Mailing Address - State:AZ
Mailing Address - Zip Code:85212-8854
Mailing Address - Country:US
Mailing Address - Phone:801-687-2333
Mailing Address - Fax:
Practice Address - Street 1:4908 S CHARGER
Practice Address - Street 2:
Practice Address - City:MESA
Practice Address - State:AZ
Practice Address - Zip Code:85212-8854
Practice Address - Country:US
Practice Address - Phone:801-687-2333
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2018-10-16
Last Update Date:2018-10-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2355S0801XSpeech, Language and Hearing Service ProvidersSpecialist/TechnologistSpeech-Language Assistant