Provider Demographics
NPI:1952683203
Name:UPSHAW, JULIE JOHN (MS CCC-SLP)
Entity Type:Individual
Prefix:MS
First Name:JULIE
Middle Name:JOHN
Last Name:UPSHAW
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 1:14219 PROTON RD
Mailing Address - Street 2:
Mailing Address - City:DALLAS
Mailing Address - State:TX
Mailing Address - Zip Code:75244-3606
Mailing Address - Country:US
Mailing Address - Phone:972-386-8993
Mailing Address - Fax:
Practice Address - Street 1:14219 PROTON RD
Practice Address - Street 2:
Practice Address - City:DALLAS
Practice Address - State:TX
Practice Address - Zip Code:75244-3606
Practice Address - Country:US
Practice Address - Phone:972-386-8993
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2011-09-13
Last Update Date:2011-09-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX104761235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist