1821187485 NPI number — JULIE K ERNEST CCC-SLP

Table of content: JULIE K ERNEST CCC-SLP (NPI 1821187485)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1821187485 NPI number — JULIE K ERNEST CCC-SLP

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
ERNEST
Provider First Name:
JULIE
Provider Middle Name:
K
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
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:
ERNEST
Provider Other First Name:
JULIE
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
MS,CCC/SLP
Provider Other Last Name Type Code:
1

NPI Number Information

NPI Number:
1821187485
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
01/07/2025
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
14130 23RD AVE N
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
PLYMOUTH
Provider Business Mailing Address State Name:
MN
Provider Business Mailing Address Postal Code:
55447
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
763-383-7666
Provider Business Mailing Address Fax Number:
763-383-6013

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
14425 8TH AVE N
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
PLYMOUTH
Provider Business Practice Location Address State Name:
MN
Provider Business Practice Location Address Postal Code:
55447-4456
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
651-260-9915
Provider Business Practice Location Address Fax Number:
763-383-6013
Provider Enumeration Date:
10/12/2006

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:  6402 , registered in the state of MN ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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

  • Identifier: 179304700 , issued by the state of ( MN ) . This identifiers is of the category "MEDICAID".
  • Identifier: 34776 . This is a "HEALTH PARTNERS" identifier , issued by the state of ( MN ) . This identifiers is of the category "OTHER".
  • Identifier: 54M23ER . This is a "BLUE CROSS BLUE SHEILD" identifier , issued by the state of ( MN ) . This identifiers is of the category "OTHER".
  • Identifier: 4600382 . This is a "CBSA" identifier , issued by the state of ( MN ) . This identifiers is of the category "OTHER".
  • Identifier: 205451043548 . This is a "PREFERRED ONE" identifier , issued by the state of ( MN ) . This identifiers is of the category "OTHER".
  • Identifier: 4600382 . This is a "MEDICA" identifier , issued by the state of ( MN ) . This identifiers is of the category "OTHER".
  • Identifier: 181363 . This is a "U CARE" identifier , issued by the state of ( MN ) . This identifiers is of the category "OTHER".




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