Provider Demographics
NPI:1245338482
Name:COLE, JULIE ANNE (MA, CCC-SLP)
Entity type:Individual
Prefix:
First Name:JULIE
Middle Name:ANNE
Last Name:COLE
Suffix:
Gender:F
Credentials:MA, CCC-SLP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5064 S RAINBOW BLVD
Mailing Address - Street 2:#205
Mailing Address - City:LAS VEGAS
Mailing Address - State:NV
Mailing Address - Zip Code:89118-0929
Mailing Address - Country:US
Mailing Address - Phone:702-367-4964
Mailing Address - Fax:
Practice Address - Street 1:501 S RANCHO DR
Practice Address - Street 2:STE D-25
Practice Address - City:LAS VEGAS
Practice Address - State:NV
Practice Address - Zip Code:89106-4828
Practice Address - Country:US
Practice Address - Phone:702-898-5297
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-09-20
Last Update Date:2007-07-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NVSP-380235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist
Provider Identifiers
StateIdentifier IDID TypeIssuer
NV003402209Medicaid