Individual
JUDITH RAE JULIEN
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
CCC-SP
Contact information
Practice address
4510 N 37TH AVE, PHOENIX, AZ 85019-3206
(602) 336-2990
Mailing address
19832 N 47TH AVE, GLENDALE, AZ 85308-5115
(623) 842-3947
Taxonomy
Speciality
Code
Description
License number
State
235Z00000X
Speech-Language Pathologist
Primary
SLP1119
AZ
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
572942
AHCCS PROVIDER NUMBER
AZ
Enumeration date
01/30/2007
Last updated
07/08/2007
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