Provider Demographics
NPI:1760786669
Name:WHITEHEAD, JULIE ANN (MS, CCC/SLP, L)
Entity Type:Individual
Prefix:MRS
First Name:JULIE
Middle Name:ANN
Last Name:WHITEHEAD
Suffix:
Gender:F
Credentials:MS, CCC/SLP, L
Other - Prefix:MRS
Other - First Name:JULIE
Other - Middle Name:A
Other - Last Name:MUIR-WHITEHEAD
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:MS, CCC/SLP, L
Mailing Address - Street 1:475 MAHARD DR
Mailing Address - Street 2:
Mailing Address - City:TWIN FALLS
Mailing Address - State:ID
Mailing Address - Zip Code:83301-0275
Mailing Address - Country:US
Mailing Address - Phone:208-735-9022
Mailing Address - Fax:208-735-9022
Practice Address - Street 1:475 MAHARD DR
Practice Address - Street 2:
Practice Address - City:TWIN FALLS
Practice Address - State:ID
Practice Address - Zip Code:83301-0275
Practice Address - Country:US
Practice Address - Phone:208-969-0987
Practice Address - Fax:208-735-9022
Is Sole Proprietor?:Yes
Enumeration Date:2011-01-06
Last Update Date:2011-01-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IDSLP-1507235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist