Provider Demographics
NPI:1982086542
Name:PESCOR, JULIA LYNN
Entity Type:Individual
Prefix:
First Name:JULIA
Middle Name:LYNN
Last Name:PESCOR
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:468 LONG BRANCH RD
Mailing Address - Street 2:
Mailing Address - City:SEAFORD
Mailing Address - State:DE
Mailing Address - Zip Code:19973-6252
Mailing Address - Country:US
Mailing Address - Phone:302-628-0896
Mailing Address - Fax:
Practice Address - Street 1:468 LONG BRANCH RD
Practice Address - Street 2:
Practice Address - City:SEAFORD
Practice Address - State:DE
Practice Address - Zip Code:19973-6252
Practice Address - Country:US
Practice Address - Phone:302-628-0896
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2015-06-19
Last Update Date:2015-06-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
DE01-0000521235Z00000X
MD04517235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist