Provider Demographics
NPI:1184361081
Name:REAVIS, JULIA ALYSE (SLP)
Entity type:Individual
Prefix:
First Name:JULIA
Middle Name:ALYSE
Last Name:REAVIS
Suffix:
Gender:F
Credentials:SLP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:224 VICTORIA DR
Mailing Address - Street 2:
Mailing Address - City:ROYSE CITY
Mailing Address - State:TX
Mailing Address - Zip Code:75189-8577
Mailing Address - Country:US
Mailing Address - Phone:903-268-5404
Mailing Address - Fax:
Practice Address - Street 1:810 E OLD GREENVILLE RD
Practice Address - Street 2:
Practice Address - City:ROYSE CITY
Practice Address - State:TX
Practice Address - Zip Code:75189-4524
Practice Address - Country:US
Practice Address - Phone:972-636-9514
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2022-05-12
Last Update Date:2022-05-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX16083235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist