Provider Demographics
NPI:1770064693
Name:PETERS, JULIANNA (MA-CCC-SLP)
Entity type:Individual
Prefix:
First Name:JULIANNA
Middle Name:
Last Name:PETERS
Suffix:
Gender:F
Credentials:MA-CCC-SLP
Other - Prefix:
Other - First Name:JULIANNA
Other - Middle Name:
Other - Last Name:PERRELLI
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:MA-CCC-SLP
Mailing Address - Street 1:1004 BALAYE VISTA CIR APT 302
Mailing Address - Street 2:
Mailing Address - City:TAMPA
Mailing Address - State:FL
Mailing Address - Zip Code:33619-5095
Mailing Address - Country:US
Mailing Address - Phone:804-652-9300
Mailing Address - Fax:
Practice Address - Street 1:1226 MARINER BLVD
Practice Address - Street 2:
Practice Address - City:SPRING HILL
Practice Address - State:FL
Practice Address - Zip Code:34609-5657
Practice Address - Country:US
Practice Address - Phone:727-376-1111
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2018-08-28
Last Update Date:2019-07-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA2202004824235Z00000X
FLSA14233235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist