Provider Demographics
NPI:1205319365
Name:SWEDBURG, JULIE (MS, CCC-SLP)
Entity type:Individual
Prefix:
First Name:JULIE
Middle Name:
Last Name:SWEDBURG
Suffix:
Gender:F
Credentials:MS, CCC-SLP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2495 MAPLEWOOD DR STE 313
Mailing Address - Street 2:
Mailing Address - City:MAPLEWOOD
Mailing Address - State:MN
Mailing Address - Zip Code:55109-1985
Mailing Address - Country:US
Mailing Address - Phone:651-770-8884
Mailing Address - Fax:651-770-8151
Practice Address - Street 1:2495 MAPLEWOOD DR STE 313
Practice Address - Street 2:
Practice Address - City:MAPLEWOOD
Practice Address - State:MN
Practice Address - Zip Code:55109-1985
Practice Address - Country:US
Practice Address - Phone:651-770-8884
Practice Address - Fax:651-770-8151
Is Sole Proprietor?:No
Enumeration Date:2018-09-13
Last Update Date:2018-09-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MN7769235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist
Provider Identifiers
StateIdentifier IDID TypeIssuer
MN01022029OtherASHA