Individual
JULIA KETCHAM
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
SLP
Contact information
Practice address
3320 N CLINTON ST, FORT WAYNE, IN 46805-1918
(260) 483-2100
Mailing address
8442 CERCO CT, FORT WAYNE, IN 46815-5713
(260) 485-4672
Taxonomy
Speciality
Code
Description
License number
State
235Z00000X
Speech-Language Pathologist
Primary
22000296A
IN
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
0000000265744
BLUE CROSS BLUE SHIELD
IN
Enumeration date
02/21/2007
Last updated
07/08/2007
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