Provider Demographics
NPI:1255535373
Name:KUBIN, JULIE LYNN (MS, CCC-SLP)
Entity type:Individual
Prefix:MRS
First Name:JULIE
Middle Name:LYNN
Last Name:KUBIN
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 1:1716 PRESTWICK LN
Mailing Address - Street 2:
Mailing Address - City:ENNIS
Mailing Address - State:TX
Mailing Address - Zip Code:75119-1195
Mailing Address - Country:US
Mailing Address - Phone:972-875-2410
Mailing Address - Fax:
Practice Address - Street 1:3002 W 2ND AVE
Practice Address - Street 2:
Practice Address - City:CORSICANA
Practice Address - State:TX
Practice Address - Zip Code:75110-2408
Practice Address - Country:US
Practice Address - Phone:903-641-0545
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-06-13
Last Update Date:2008-03-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX103120235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist