Provider Demographics
NPI:1811190259
Name:CLEMENTE, JULIE ANN (MS,CCC/SLP,CEIS)
Entity type:Individual
Prefix:MRS
First Name:JULIE
Middle Name:ANN
Last Name:CLEMENTE
Suffix:
Gender:F
Credentials:MS,CCC/SLP,CEIS
Other - Prefix:
Other - First Name:JULIE
Other - Middle Name:ANN
Other - Last Name:SELLA
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:MS,CCC/SLP,CEIS
Mailing Address - Street 1:18 AUSTIN ROAD
Mailing Address - Street 2:
Mailing Address - City:MEDFORD
Mailing Address - State:MA
Mailing Address - Zip Code:02155
Mailing Address - Country:US
Mailing Address - Phone:617-699-0446
Mailing Address - Fax:
Practice Address - Street 1:18 AUSTIN ROAD
Practice Address - Street 2:
Practice Address - City:MEDFORD
Practice Address - State:MA
Practice Address - Zip Code:02155
Practice Address - Country:US
Practice Address - Phone:617-699-0446
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-06-05
Last Update Date:2012-04-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MASP 6708-SL235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist
Provider Identifiers
StateIdentifier IDID TypeIssuer
MASP0219OtherBCBS OF MA