Provider Demographics
NPI:1265901151
Name:MAISLEN, JULIE SHANNON (CCC-SLP)
Entity type:Individual
Prefix:
First Name:JULIE
Middle Name:SHANNON
Last Name:MAISLEN
Suffix:
Gender:F
Credentials:CCC-SLP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:10 WIGGIN WAY
Mailing Address - Street 2:
Mailing Address - City:STRATHAM
Mailing Address - State:NH
Mailing Address - Zip Code:03885-2486
Mailing Address - Country:US
Mailing Address - Phone:603-316-8001
Mailing Address - Fax:
Practice Address - Street 1:21 ACADEMY ST
Practice Address - Street 2:
Practice Address - City:EPPING
Practice Address - State:NH
Practice Address - Zip Code:03042-2911
Practice Address - Country:US
Practice Address - Phone:603-316-8001
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2018-11-20
Last Update Date:2021-06-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NHP-0752235Z00000X
NH14194701235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist
Provider Identifiers
StateIdentifier IDID TypeIssuer
14194701OtherASHA
NHP-0752OtherNH BOARD OF ALLIED HEALTH