Provider Demographics
NPI:1134436595
Name:ELLERSTON, JULIA KATHRYN (MA, CCC-SLP)
Entity type:Individual
Prefix:MISS
First Name:JULIA
Middle Name:KATHRYN
Last Name:ELLERSTON
Suffix:
Gender:F
Credentials:MA, CCC-SLP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
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Other - Credentials:
Mailing Address - Street 1:1021 CLINTON ST
Mailing Address - Street 2:UNIT 2
Mailing Address - City:PHILADELPHIA
Mailing Address - State:PA
Mailing Address - Zip Code:19107-6086
Mailing Address - Country:US
Mailing Address - Phone:515-570-2047
Mailing Address - Fax:
Practice Address - Street 1:1021 CLINTON ST
Practice Address - Street 2:UNIT 2
Practice Address - City:PHILADELPHIA
Practice Address - State:PA
Practice Address - Zip Code:19107-6086
Practice Address - Country:US
Practice Address - Phone:515-570-2047
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2010-09-07
Last Update Date:2021-12-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PASL009971235Z00000X
IA001381235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist