Provider Demographics
NPI:1942680566
Name:BLOODWORTH, JULIE KRISTINE (MS)
Entity Type:Individual
Prefix:MRS
First Name:JULIE
Middle Name:KRISTINE
Last Name:BLOODWORTH
Suffix:
Gender:F
Credentials:MS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:60 2ND ST
Mailing Address - Street 2:STE 307
Mailing Address - City:SHALIMAR
Mailing Address - State:FL
Mailing Address - Zip Code:32579-1769
Mailing Address - Country:US
Mailing Address - Phone:850-613-6599
Mailing Address - Fax:850-613-6515
Practice Address - Street 1:60 2ND ST
Practice Address - Street 2:STE 307
Practice Address - City:SHALIMAR
Practice Address - State:FL
Practice Address - Zip Code:32579-1769
Practice Address - Country:US
Practice Address - Phone:850-613-6599
Practice Address - Fax:850-613-6515
Is Sole Proprietor?:Yes
Enumeration Date:2015-06-09
Last Update Date:2015-06-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLSZ7096235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist