Provider Demographics
NPI:1720794464
Name:SLOBODA, JULIA HELENE (CCC-SLP)
Entity Type:Individual
Prefix:
First Name:JULIA
Middle Name:HELENE
Last Name:SLOBODA
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 1:60 GEORGE ST APT 1
Mailing Address - Street 2:
Mailing Address - City:TROY
Mailing Address - State:NY
Mailing Address - Zip Code:12183-1114
Mailing Address - Country:US
Mailing Address - Phone:360-325-1781
Mailing Address - Fax:
Practice Address - Street 1:60 GEORGE ST APT 1
Practice Address - Street 2:
Practice Address - City:TROY
Practice Address - State:NY
Practice Address - Zip Code:12183-1114
Practice Address - Country:US
Practice Address - Phone:360-325-1781
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2023-01-26
Last Update Date:2023-01-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY032748235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist