Provider Demographics
NPI:1487253845
Name:BROWN, JULIE
Entity type:Individual
Prefix:
First Name:JULIE
Middle Name:
Last Name:BROWN
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 1:529 CHIMNEY ROCK LOOP
Mailing Address - Street 2:
Mailing Address - City:GRANITE CANON
Mailing Address - State:WY
Mailing Address - Zip Code:82059-4004
Mailing Address - Country:US
Mailing Address - Phone:307-399-5186
Mailing Address - Fax:
Practice Address - Street 1:529 CHIMNEY ROCK LOOP
Practice Address - Street 2:
Practice Address - City:GRANITE CANON
Practice Address - State:WY
Practice Address - Zip Code:82059-4004
Practice Address - Country:US
Practice Address - Phone:307-399-5186
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2020-10-18
Last Update Date:2020-10-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WYSP-1132235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist