Provider Demographics
NPI:1760569727
Name:PERREAULT, JULIE ANN (AUD)
Entity Type:Individual
Prefix:DR
First Name:JULIE
Middle Name:ANN
Last Name:PERREAULT
Suffix:
Gender:F
Credentials:AUD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1068 S LAKE STREET
Mailing Address - Street 2:SUITE 108
Mailing Address - City:FOREST LAKE
Mailing Address - State:MN
Mailing Address - Zip Code:55025
Mailing Address - Country:US
Mailing Address - Phone:651-464-8486
Mailing Address - Fax:651-464-8747
Practice Address - Street 1:1068 S LAKE STREET
Practice Address - Street 2:SUITE 108
Practice Address - City:FOREST LAKE
Practice Address - State:MN
Practice Address - Zip Code:55025
Practice Address - Country:US
Practice Address - Phone:651-464-8486
Practice Address - Fax:651-464-8747
Is Sole Proprietor?:No
Enumeration Date:2006-11-01
Last Update Date:2021-03-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MN6007231H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes231H00000XSpeech, Language and Hearing Service ProvidersAudiologist
Provider Identifiers
StateIdentifier IDID TypeIssuer
MN56981PEOtherBCBS OF MN
640003663OtherRAILROAD MEDICARE
114370OtherUCARE
41394OtherHEALTH PARTNERS
1011302OtherPREFERRED ONE
MN5G979EAOtherBCBS OF MN
MN908265400Medicaid
4511558OtherMEDICA CHOICE
MN5G979EAOtherBCBS OF MN