Provider Demographics
NPI:1750361861
Name:MANCHE, JULIE M (AUD)
Entity type:Individual
Prefix:
First Name:JULIE
Middle Name:M
Last Name:MANCHE
Suffix:
Gender:F
Credentials:AUD
Other - Prefix:
Other - First Name:JULIE
Other - Middle Name:
Other - Last Name:MASON
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:
Mailing Address - Street 1:207 WESTWOOD DR
Mailing Address - Street 2:
Mailing Address - City:LOUISVILLE
Mailing Address - State:KY
Mailing Address - Zip Code:40243-2040
Mailing Address - Country:US
Mailing Address - Phone:502-276-5755
Mailing Address - Fax:
Practice Address - Street 1:105 DAVENTRY LN
Practice Address - Street 2:SUITE 100
Practice Address - City:LOUISVILLE
Practice Address - State:KY
Practice Address - Zip Code:40223-2879
Practice Address - Country:US
Practice Address - Phone:502-276-5755
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-01-17
Last Update Date:2011-04-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KYKY0439231H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes231H00000XSpeech, Language and Hearing Service ProvidersAudiologist