Provider Demographics
NPI:1265734321
Name:ABBOTT, JULIE M (MA CCC/SLP)
Entity type:Individual
Prefix:
First Name:JULIE
Middle Name:M
Last Name:ABBOTT
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 1:36950 ROCKSPRINGS RD
Mailing Address - Street 2:
Mailing Address - City:POMEROY
Mailing Address - State:OH
Mailing Address - Zip Code:45769-9730
Mailing Address - Country:US
Mailing Address - Phone:937-248-6451
Mailing Address - Fax:
Practice Address - Street 1:36871 STATE ROUTE 124
Practice Address - Street 2:
Practice Address - City:MIDDLEPORT
Practice Address - State:OH
Practice Address - Zip Code:45760-9733
Practice Address - Country:US
Practice Address - Phone:937-248-6451
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2010-11-23
Last Update Date:2022-07-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OHOH3020334235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist