Provider Demographics
NPI:1134347438
Name:FONTANA, JULIE ANN (LDO,ABOC,HIS)
Entity type:Individual
Prefix:MRS
First Name:JULIE
Middle Name:ANN
Last Name:FONTANA
Suffix:
Gender:F
Credentials:LDO,ABOC,HIS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1437 SYCAMORE LINE
Mailing Address - Street 2:
Mailing Address - City:SANDUSKY
Mailing Address - State:OH
Mailing Address - Zip Code:44870-4136
Mailing Address - Country:US
Mailing Address - Phone:419-625-4646
Mailing Address - Fax:419-625-4690
Practice Address - Street 1:1437 SYCAMORE LINE
Practice Address - Street 2:
Practice Address - City:SANDUSKY
Practice Address - State:OH
Practice Address - Zip Code:44870-4136
Practice Address - Country:US
Practice Address - Phone:419-625-4646
Practice Address - Fax:419-625-4690
Is Sole Proprietor?:Yes
Enumeration Date:2007-04-23
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH02692237700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes237700000XSpeech, Language and Hearing Service ProvidersHearing Instrument Specialist