Provider Demographics
NPI:1366551129
Name:JARRELL, JULIE A (AUD)
Entity type:Individual
Prefix:DR
First Name:JULIE
Middle Name:A
Last Name:JARRELL
Suffix:
Gender:F
Credentials:AUD
Other - Prefix:DR
Other - First Name:JULIE
Other - Middle Name:U
Other - Last Name:FEGEBANK
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:AUD
Mailing Address - Street 1:3900 DONNINGTON DR
Mailing Address - Street 2:
Mailing Address - City:VIRGINIA BEACH
Mailing Address - State:VA
Mailing Address - Zip Code:23456-5769
Mailing Address - Country:US
Mailing Address - Phone:757-689-0866
Mailing Address - Fax:
Practice Address - Street 1:3900 DONNINGTON DR
Practice Address - Street 2:
Practice Address - City:VIRGINIA BEACH
Practice Address - State:VA
Practice Address - Zip Code:23456-5769
Practice Address - Country:US
Practice Address - Phone:757-689-0866
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-08-29
Last Update Date:2015-02-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA2201001389231H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes231H00000XSpeech, Language and Hearing Service ProvidersAudiologist
Provider Identifiers
StateIdentifier IDID TypeIssuer
VA2201001389OtherVIRGINIA STATE AUDIOLOGY LICENSE
FL600154800Medicaid
FL600154800Medicaid