Provider Demographics
NPI:1700668886
Name:BOSCO, JULIA MARIE (CCC-SLP)
Entity type:Individual
Prefix:
First Name:JULIA
Middle Name:MARIE
Last Name:BOSCO
Suffix:
Gender:F
Credentials:CCC-SLP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5404 E CORTLAND BLVD APT 200
Mailing Address - Street 2:
Mailing Address - City:FLAGSTAFF
Mailing Address - State:AZ
Mailing Address - Zip Code:86004-2505
Mailing Address - Country:US
Mailing Address - Phone:860-501-2349
Mailing Address - Fax:
Practice Address - Street 1:55 KENT LN
Practice Address - Street 2:
Practice Address - City:NASHUA
Practice Address - State:NH
Practice Address - Zip Code:03062-2807
Practice Address - Country:US
Practice Address - Phone:603-821-1200
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2023-10-16
Last Update Date:2023-10-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MASLP100706235Z00000X
AZSLP14120235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist