Individual
JULIE D REVILLE
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
MS CCCSLP
Contact information
Practice address
2 CHURCH ST, SUITE 4G, BURLINGTON, VT 05401-4299
(802) 734-0777
Mailing address
2 CHURCH ST, SUITE 4G, BURLINGTON, VT 05401-4299
(802) 734-0777
Taxonomy
Speciality
Code
Description
License number
State
101YM0800X
Mental Health Counselor
Primary
068-0000747
VT
235Z00000X
Speech-Language Pathologist
01038597
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
00049731
BLUE CROSS BLUE SHIELD
—
01
—
4149910
MVP
—
Enumeration date
03/26/2007
Last updated
07/23/2008
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