Provider Demographics
NPI:1942756135
Name:BYRD, JULIANE (MS CCC/SLP)
Entity Type:Individual
Prefix:
First Name:JULIANE
Middle Name:
Last Name:BYRD
Suffix:
Gender:F
Credentials:MS CCC/SLP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:7547 YELLOW FIN DR UNIT 101
Mailing Address - Street 2:
Mailing Address - City:JACKSONVILLE
Mailing Address - State:FL
Mailing Address - Zip Code:32256-2100
Mailing Address - Country:US
Mailing Address - Phone:407-697-1760
Mailing Address - Fax:
Practice Address - Street 1:7547 YELLOW FIN DR UNIT 101
Practice Address - Street 2:
Practice Address - City:JACKSONVILLE
Practice Address - State:FL
Practice Address - Zip Code:32256-2100
Practice Address - Country:US
Practice Address - Phone:407-697-1760
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2016-08-29
Last Update Date:2016-08-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLSA-1781235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist