Provider Demographics
NPI:1750826079
Name:BOMIA, JULIANNE MARIE (MA, CCC-SLP)
Entity Type:Individual
Prefix:MRS
First Name:JULIANNE
Middle Name:MARIE
Last Name:BOMIA
Suffix:
Gender:F
Credentials:MA, CCC-SLP
Other - Prefix:
Other - First Name:
Other - Middle Name:
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Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1908 W MILHAM AVE
Mailing Address - Street 2:
Mailing Address - City:PORTAGE
Mailing Address - State:MI
Mailing Address - Zip Code:49024-1232
Mailing Address - Country:US
Mailing Address - Phone:616-333-2721
Mailing Address - Fax:616-719-1932
Practice Address - Street 1:1908 W MILHAM AVE
Practice Address - Street 2:
Practice Address - City:PORTAGE
Practice Address - State:MI
Practice Address - Zip Code:49024-1232
Practice Address - Country:US
Practice Address - Phone:269-459-6212
Practice Address - Fax:269-585-6068
Is Sole Proprietor?:No
Enumeration Date:2016-12-21
Last Update Date:2019-02-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI7101004037235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist