Provider Demographics
NPI:1932838372
Name:ELLIOTT, JULIE KRISTIN (MA CCC-SLP)
Entity Type:Individual
Prefix:
First Name:JULIE
Middle Name:KRISTIN
Last Name:ELLIOTT
Suffix:
Gender:F
Credentials:MA CCC-SLP
Other - Prefix:
Other - First Name:JULIE
Other - Middle Name:KRISTIN
Other - Last Name:BENNETT
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:MA CCC-SLPK
Mailing Address - Street 1:42842 LOMBARDY DR
Mailing Address - Street 2:
Mailing Address - City:CANTON
Mailing Address - State:MI
Mailing Address - Zip Code:48187-2321
Mailing Address - Country:US
Mailing Address - Phone:734-436-1980
Mailing Address - Fax:
Practice Address - Street 1:42842 LOMBARDY DR
Practice Address - Street 2:
Practice Address - City:CANTON
Practice Address - State:MI
Practice Address - Zip Code:48187-2321
Practice Address - Country:US
Practice Address - Phone:734-436-1980
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2022-06-09
Last Update Date:2022-07-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist