1699803098 NPI number — MRS. JULIA CAROLYN CHILDS MS-CCC-SLP

Table of content: MRS. JULIA CAROLYN CHILDS MS-CCC-SLP (NPI 1699803098)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1699803098 NPI number — MRS. JULIA CAROLYN CHILDS MS-CCC-SLP

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
CHILDS
Provider First Name:
JULIA
Provider Middle Name:
CAROLYN
Provider Name Prefix Text:
MRS.
Provider Name Suffix Text:
Provider Credential Text:
MS-CCC-SLP
Provider Gender Code:
F

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1699803098
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
10/18/2020
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
113 CHERRYWOOD DR
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
GLENSHAW
Provider Business Mailing Address State Name:
PA
Provider Business Mailing Address Postal Code:
15116-2601
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
412-213-0092
Provider Business Mailing Address Fax Number:

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
3390 SAXONBURG BLVD # 250
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
GLENSHAW
Provider Business Practice Location Address State Name:
PA
Provider Business Practice Location Address Postal Code:
15116-3160
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
412-767-5967
Provider Business Practice Location Address Fax Number:
Provider Enumeration Date:
02/28/2007

Additional Information

Authorized Official

Authorized Official Last Name:
Authorized Official First Name:
Authorized Official Middle Name:
Authorized Official Title or Position:
Authorized Official Telephone Number:

Provider Taxonomy Codes

  • Taxonomy code: 235Z00000X , with the licence number:  SL 007970 , registered in the state of PA ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)

  • Identifier: 101117584 , issued by the state of ( PA ) . This identifiers is of the category "MEDICAID".




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