Provider Demographics
NPI:1265987507
Name:GEERTSEMA, JULIA (MA, CCC-SLP)
Entity type:Individual
Prefix:
First Name:JULIA
Middle Name:
Last Name:GEERTSEMA
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 1:2426 ELROD CT
Mailing Address - Street 2:
Mailing Address - City:YUMA
Mailing Address - State:AZ
Mailing Address - Zip Code:85365-6442
Mailing Address - Country:US
Mailing Address - Phone:928-502-8517
Mailing Address - Fax:
Practice Address - Street 1:2251 S OTONDO DR
Practice Address - Street 2:
Practice Address - City:YUMA
Practice Address - State:AZ
Practice Address - Zip Code:85365-8843
Practice Address - Country:US
Practice Address - Phone:928-502-8517
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2016-08-16
Last Update Date:2016-08-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZSLP10130235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist