Provider Demographics
NPI:1972279149
Name:MOHN, JULIA KAYE (MA, CCC-SLP)
Entity Type:Individual
Prefix:
First Name:JULIA
Middle Name:KAYE
Last Name:MOHN
Suffix:
Gender:F
Credentials:MA, CCC-SLP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:14060 BIG CREST LN APT 305
Mailing Address - Street 2:
Mailing Address - City:WOODBRIDGE
Mailing Address - State:VA
Mailing Address - Zip Code:22191-5537
Mailing Address - Country:US
Mailing Address - Phone:484-663-4746
Mailing Address - Fax:
Practice Address - Street 1:100 WOOD DR
Practice Address - Street 2:
Practice Address - City:STAFFORD
Practice Address - State:VA
Practice Address - Zip Code:22556-1838
Practice Address - Country:US
Practice Address - Phone:540-658-6240
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2021-08-18
Last Update Date:2021-12-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA2204000550235Z00000X
VA2202010124235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist