Provider Demographics
NPI:1649887134
Name:DITTUS, JULIANNA WHITELEY
Entity type:Individual
Prefix:
First Name:JULIANNA
Middle Name:WHITELEY
Last Name:DITTUS
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 1:1639 S FLORENCE PL
Mailing Address - Street 2:
Mailing Address - City:TULSA
Mailing Address - State:OK
Mailing Address - Zip Code:74104-5214
Mailing Address - Country:US
Mailing Address - Phone:918-851-0347
Mailing Address - Fax:
Practice Address - Street 1:1639 S FLORENCE PL
Practice Address - Street 2:
Practice Address - City:TULSA
Practice Address - State:OK
Practice Address - Zip Code:74104-5214
Practice Address - Country:US
Practice Address - Phone:918-851-0347
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2020-09-28
Last Update Date:2020-09-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language PathologistGroup - Single Specialty