Provider Demographics
NPI:1184934374
Name:CRAINE, JULIA CALDWELL
Entity type:Individual
Prefix:
First Name:JULIA
Middle Name:CALDWELL
Last Name:CRAINE
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:13 LOCUST STREET
Mailing Address - Street 2:
Mailing Address - City:GLENS FALLS
Mailing Address - State:NY
Mailing Address - Zip Code:12801
Mailing Address - Country:US
Mailing Address - Phone:518-761-2025
Mailing Address - Fax:518-761-2035
Practice Address - Street 1:133 AVIATION RD
Practice Address - Street 2:
Practice Address - City:QUEENSBURY
Practice Address - State:NY
Practice Address - Zip Code:12804-8206
Practice Address - Country:US
Practice Address - Phone:518-798-0170
Practice Address - Fax:518-761-9538
Is Sole Proprietor?:No
Enumeration Date:2010-10-21
Last Update Date:2015-04-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY020133235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY00752456Medicaid