Provider Demographics
NPI:1295082782
Name:BURNS, JULIE THOMSON (MS, CCC/SLP)
Entity type:Individual
Prefix:MRS
First Name:JULIE
Middle Name:THOMSON
Last Name:BURNS
Suffix:
Gender:F
Credentials:MS, CCC/SLP
Other - Prefix:
Other - First Name:JULIE
Other - Middle Name:LYNN
Other - Last Name:THOMSON
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:275 S. UNIVERSITY ST., CAMPUS BOX 4720
Mailing Address - Street 2:ECKELMANN-TAYLOR SPEECH AND HEARING CLINIC
Mailing Address - City:NORMAL
Mailing Address - State:IL
Mailing Address - Zip Code:61761
Mailing Address - Country:US
Mailing Address - Phone:309-438-8641
Mailing Address - Fax:
Practice Address - Street 1:CAMPUS BOX 4720
Practice Address - Street 2:ECKELMANN-TAYLOR SPEECH AND HEARING CLINIC
Practice Address - City:NORMAL
Practice Address - State:IL
Practice Address - Zip Code:61761
Practice Address - Country:US
Practice Address - Phone:309-438-8641
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2012-08-14
Last Update Date:2012-08-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL146001421235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist