Provider Demographics
NPI:1831856251
Name:BRYAN, JULIE (MS CCC-SLP)
Entity type:Individual
Prefix:
First Name:JULIE
Middle Name:
Last Name:BRYAN
Suffix:
Gender:F
Credentials:MS CCC-SLP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1502 SUNNY DAYS DR
Mailing Address - Street 2:
Mailing Address - City:KNIGHTDALE
Mailing Address - State:NC
Mailing Address - Zip Code:27545-6393
Mailing Address - Country:US
Mailing Address - Phone:910-264-2156
Mailing Address - Fax:
Practice Address - Street 1:3609 BOND ST
Practice Address - Street 2:
Practice Address - City:RALEIGH
Practice Address - State:NC
Practice Address - Zip Code:27604-3801
Practice Address - Country:US
Practice Address - Phone:811-391-9231
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2021-11-19
Last Update Date:2021-11-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC13983235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist