Provider Demographics
NPI:1134260334
Name:YOUNGBLOOD, JULIA MARY
Entity type:Individual
Prefix:MRS
First Name:JULIA
Middle Name:MARY
Last Name:YOUNGBLOOD
Suffix:
Gender:F
Credentials:
Other - Prefix:MISS
Other - First Name:JULIA
Other - Middle Name:MARY
Other - Last Name:MEHLENBACHER
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:633 ENTERPRISE RD
Mailing Address - Street 2:
Mailing Address - City:LITTLETON
Mailing Address - State:NC
Mailing Address - Zip Code:27850-8179
Mailing Address - Country:US
Mailing Address - Phone:252-586-5600
Mailing Address - Fax:
Practice Address - Street 1:536 HAMILTON ST
Practice Address - Street 2:
Practice Address - City:ROANOKE RAPIDS
Practice Address - State:NC
Practice Address - Zip Code:27870-2702
Practice Address - Country:US
Practice Address - Phone:252-519-7103
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-02-09
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC5455235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist