Provider Demographics
NPI:1720434129
Name:MUSKO, JULIE (MA)
Entity Type:Individual
Prefix:
First Name:JULIE
Middle Name:
Last Name:MUSKO
Suffix:
Gender:F
Credentials:MA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1133 HUFF RD NW
Mailing Address - Street 2:APT 439
Mailing Address - City:ATLANTA
Mailing Address - State:GA
Mailing Address - Zip Code:30318-7708
Mailing Address - Country:US
Mailing Address - Phone:618-889-2832
Mailing Address - Fax:
Practice Address - Street 1:324 STEVENS ENTRY
Practice Address - Street 2:SUITE A-1
Practice Address - City:PEACHTREE CITY
Practice Address - State:GA
Practice Address - Zip Code:30269-1325
Practice Address - Country:US
Practice Address - Phone:678-619-0178
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2016-05-04
Last Update Date:2016-05-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GASLP009001235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist