Provider Demographics
NPI:1790463354
Name:KOLOUCH, JULIA ANNE (MED)
Entity Type:Individual
Prefix:
First Name:JULIA
Middle Name:ANNE
Last Name:KOLOUCH
Suffix:
Gender:F
Credentials:MED
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:200 E NAVAJO ST
Mailing Address - Street 2:
Mailing Address - City:WEST LAFAYETTE
Mailing Address - State:IN
Mailing Address - Zip Code:47906-2155
Mailing Address - Country:US
Mailing Address - Phone:617-283-7231
Mailing Address - Fax:
Practice Address - Street 1:200 E NAVAJO ST
Practice Address - Street 2:
Practice Address - City:WEST LAFAYETTE
Practice Address - State:IN
Practice Address - Zip Code:47906-2155
Practice Address - Country:US
Practice Address - Phone:617-283-7231
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2023-07-05
Last Update Date:2023-07-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes222Q00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersDevelopmental Therapist