Provider Demographics
NPI:1265944375
Name:BLANTON, JULIA BRADFORD (MED CCC-SLP)
Entity type:Individual
Prefix:
First Name:JULIA
Middle Name:BRADFORD
Last Name:BLANTON
Suffix:
Gender:F
Credentials:MED CCC-SLP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:228 BAYWOOD CIR
Mailing Address - Street 2:
Mailing Address - City:LAGRANGE
Mailing Address - State:GA
Mailing Address - Zip Code:30240-6365
Mailing Address - Country:US
Mailing Address - Phone:706-402-4624
Mailing Address - Fax:
Practice Address - Street 1:228 BAYWOOD CIR
Practice Address - Street 2:
Practice Address - City:LAGRANGE
Practice Address - State:GA
Practice Address - Zip Code:30240-6365
Practice Address - Country:US
Practice Address - Phone:706-402-4624
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2017-10-30
Last Update Date:2022-07-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GASLP009881235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist