Provider Demographics
NPI:1457623670
Name:GAINES, JULIE
Entity Type:Individual
Prefix:MISS
First Name:JULIE
Middle Name:
Last Name:GAINES
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 1:7 WOODSIDE DR
Mailing Address - Street 2:
Mailing Address - City:PALM COAST
Mailing Address - State:FL
Mailing Address - Zip Code:32164-7907
Mailing Address - Country:US
Mailing Address - Phone:386-447-3846
Mailing Address - Fax:
Practice Address - Street 1:3001 PALM COAST PKWY SE
Practice Address - Street 2:GRAND OAKS HEALTH AND REHAB
Practice Address - City:PALM COAST
Practice Address - State:FL
Practice Address - Zip Code:32137
Practice Address - Country:US
Practice Address - Phone:386-446-6060
Practice Address - Fax:386-446-6033
Is Sole Proprietor?:No
Enumeration Date:2012-02-03
Last Update Date:2012-02-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLSA 2887235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist