Provider Demographics
NPI:1720577166
Name:MCMILLAN, JULIA MARLENE (MS, CCC-SLP)
Entity Type:Individual
Prefix:
First Name:JULIA
Middle Name:MARLENE
Last Name:MCMILLAN
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 1:5984 S SUSQUEHANNA
Mailing Address - Street 2:
Mailing Address - City:MURRAY
Mailing Address - State:UT
Mailing Address - Zip Code:84123-5527
Mailing Address - Country:US
Mailing Address - Phone:801-656-7373
Mailing Address - Fax:
Practice Address - Street 1:5984 S SUSQUEHANNA
Practice Address - Street 2:
Practice Address - City:MURRAY
Practice Address - State:UT
Practice Address - Zip Code:84123-5527
Practice Address - Country:US
Practice Address - Phone:801-656-7373
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2018-05-01
Last Update Date:2018-05-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
UT5603918-4102235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist
Provider Identifiers
StateIdentifier IDID TypeIssuer
12120690OtherASHA NUMBER