Provider Demographics
NPI:1366251290
Name:HUYNH, JULIA (MS CFY-SLP)
Entity type:Individual
Prefix:
First Name:JULIA
Middle Name:
Last Name:HUYNH
Suffix:
Gender:F
Credentials:MS CFY-SLP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:24989 LAYTON RD
Mailing Address - Street 2:
Mailing Address - City:SOUTH BEND
Mailing Address - State:IN
Mailing Address - Zip Code:46614-8903
Mailing Address - Country:US
Mailing Address - Phone:574-329-2680
Mailing Address - Fax:
Practice Address - Street 1:3305 GRAPE RD STE 3
Practice Address - Street 2:
Practice Address - City:MISHAWAKA
Practice Address - State:IN
Practice Address - Zip Code:46545-2714
Practice Address - Country:US
Practice Address - Phone:574-217-7423
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2025-01-06
Last Update Date:2025-01-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN46004630A235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language PathologistGroup - Single Specialty