Provider Demographics
NPI:1790988731
Name:WILEY, JULIE NICOLE (AUD)
Entity Type:Individual
Prefix:MS
First Name:JULIE
Middle Name:NICOLE
Last Name:WILEY
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:PO BOX 152198
Mailing Address - Street 2:
Mailing Address - City:TAMPA
Mailing Address - State:FL
Mailing Address - Zip Code:33684-2198
Mailing Address - Country:US
Mailing Address - Phone:813-293-2384
Mailing Address - Fax:
Practice Address - Street 1:3007 RIDGELINE BLVD STE A
Practice Address - Street 2:
Practice Address - City:TARPON SPRINGS
Practice Address - State:FL
Practice Address - Zip Code:34688-9103
Practice Address - Country:US
Practice Address - Phone:727-942-4005
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-06-07
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLAY923231H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes231H00000XSpeech, Language and Hearing Service ProvidersAudiologist