Provider Demographics
NPI:1720439011
Name:PELDO, JULIE (CCC-SLP)
Entity Type:Individual
Prefix:MRS
First Name:JULIE
Middle Name:
Last Name:PELDO
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 1:3623 DAY SPRING LN
Mailing Address - Street 2:
Mailing Address - City:SPEARFISH
Mailing Address - State:SD
Mailing Address - Zip Code:57783-4170
Mailing Address - Country:US
Mailing Address - Phone:605-641-1218
Mailing Address - Fax:
Practice Address - Street 1:525 E ILLINOIS ST
Practice Address - Street 2:
Practice Address - City:SPEARFISH
Practice Address - State:SD
Practice Address - Zip Code:57783-2521
Practice Address - Country:US
Practice Address - Phone:605-717-1201
Practice Address - Fax:605-717-1200
Is Sole Proprietor?:No
Enumeration Date:2016-06-28
Last Update Date:2016-06-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SD194-SLP235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist