Provider Demographics
NPI:1265706782
Name:ST. VRAIN, JULIE ANN (MA CCC-A)
Entity type:Individual
Prefix:MRS
First Name:JULIE
Middle Name:ANN
Last Name:ST. VRAIN
Suffix:
Gender:F
Credentials:MA CCC-A
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:750 N COMMONS DR STE 200
Mailing Address - Street 2:
Mailing Address - City:AURORA
Mailing Address - State:IL
Mailing Address - Zip Code:60504-7940
Mailing Address - Country:US
Mailing Address - Phone:630-303-5380
Mailing Address - Fax:630-303-5385
Practice Address - Street 1:10800 ALPHARETTA HWY
Practice Address - Street 2:#122
Practice Address - City:ROSWELL
Practice Address - State:GA
Practice Address - Zip Code:30076-1490
Practice Address - Country:US
Practice Address - Phone:770-992-5353
Practice Address - Fax:770-998-4974
Is Sole Proprietor?:No
Enumeration Date:2012-03-01
Last Update Date:2021-03-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GA003379231H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes231H00000XSpeech, Language and Hearing Service ProvidersAudiologist