Provider Demographics
NPI:1265762728
Name:BOOTHE, JULIEANNE BENTRUM (MS, CCC-SLP)
Entity type:Individual
Prefix:
First Name:JULIEANNE
Middle Name:BENTRUM
Last Name:BOOTHE
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 1:4500 SOJOURN DR
Mailing Address - Street 2:APT 406
Mailing Address - City:ADDISON
Mailing Address - State:TX
Mailing Address - Zip Code:75001-5086
Mailing Address - Country:US
Mailing Address - Phone:214-801-5117
Mailing Address - Fax:
Practice Address - Street 1:5521 VILLAGE CREEK DR
Practice Address - Street 2:
Practice Address - City:PLANO
Practice Address - State:TX
Practice Address - Zip Code:75093-4829
Practice Address - Country:US
Practice Address - Phone:972-477-0038
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2010-01-06
Last Update Date:2010-01-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX19406235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist