Provider Demographics
NPI:1336901412
Name:VITALE, JULIA VIOLET
Entity Type:Individual
Prefix:
First Name:JULIA
Middle Name:VIOLET
Last Name:VITALE
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:343 JERICHO RD UNIT A
Mailing Address - Street 2:
Mailing Address - City:RICHMOND
Mailing Address - State:VT
Mailing Address - Zip Code:05477-9173
Mailing Address - Country:US
Mailing Address - Phone:908-246-5110
Mailing Address - Fax:
Practice Address - Street 1:343 JERICHO RD UNIT A
Practice Address - Street 2:
Practice Address - City:RICHMOND
Practice Address - State:VT
Practice Address - Zip Code:05477-9173
Practice Address - Country:US
Practice Address - Phone:908-246-5110
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2024-01-25
Last Update Date:2024-01-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VT14286173235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist