Provider Demographics
NPI:1891248019
Name:WISNIA, JULIA
Entity Type:Individual
Prefix:
First Name:JULIA
Middle Name:
Last Name:WISNIA
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:45 BEECHCROFT ST
Mailing Address - Street 2:4
Mailing Address - City:BRIGHTON
Mailing Address - State:MA
Mailing Address - Zip Code:02135-2581
Mailing Address - Country:US
Mailing Address - Phone:781-760-9755
Mailing Address - Fax:
Practice Address - Street 1:1269 MAIN ST
Practice Address - Street 2:
Practice Address - City:CONCORD
Practice Address - State:MA
Practice Address - Zip Code:01742-3099
Practice Address - Country:US
Practice Address - Phone:978-287-7951
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2016-07-25
Last Update Date:2016-07-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist