Provider Demographics
NPI:1720692072
Name:TACY, JULIA BURROUGHS (CCC-SLP)
Entity Type:Individual
Prefix:
First Name:JULIA
Middle Name:BURROUGHS
Last Name:TACY
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 1:6619 COLERIDGE AVE
Mailing Address - Street 2:
Mailing Address - City:CINCINNATI
Mailing Address - State:OH
Mailing Address - Zip Code:45213-1936
Mailing Address - Country:US
Mailing Address - Phone:513-746-5546
Mailing Address - Fax:
Practice Address - Street 1:7672 LESOURDSVILLE WEST CHESTER RD
Practice Address - Street 2:
Practice Address - City:WEST CHESTER
Practice Address - State:OH
Practice Address - Zip Code:45069-1233
Practice Address - Country:US
Practice Address - Phone:513-777-2201
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2020-09-03
Last Update Date:2022-01-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OHSP.14013235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist