Provider Demographics
NPI:1952617409
Name:CORNACK, JULIANNA (MA, CCC/SLP)
Entity Type:Individual
Prefix:MRS
First Name:JULIANNA
Middle Name:
Last Name:CORNACK
Suffix:
Gender:F
Credentials:MA, CCC/SLP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:345 COPLEY DR
Mailing Address - Street 2:
Mailing Address - City:LANCASTER
Mailing Address - State:PA
Mailing Address - Zip Code:17601-2975
Mailing Address - Country:US
Mailing Address - Phone:813-956-2027
Mailing Address - Fax:
Practice Address - Street 1:345 COPLEY DR
Practice Address - Street 2:
Practice Address - City:LANCASTER
Practice Address - State:PA
Practice Address - Zip Code:17601-2975
Practice Address - Country:US
Practice Address - Phone:813-956-2027
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2010-08-22
Last Update Date:2010-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PASL002447L235Z00000X
FLSA3174235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist