MEDICARE: JULIA KUSTUSCH

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	235Z00000X	Speech-Language Pathologist	07812	MD

General Provider Information

NPI Number	:	1801262837
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	JULIA KUSTUSCH

Provider Business Mailing Address
First Line	:	711 PETERSBURG RD
Second Line	:
City	:	DAVIDSONVILLE
State	:	MD
Zip	:	21035-1914
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	711 PETERSBURG RD
Second Line	:
City	:	DAVIDSONVILLE
State	:	MD
Zip	:	21035-1914
Country	:	US
Telephone Number	:	443-995-4382
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	08/13/2015
Last Update Date	:	08/13/2015

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Directions to “ JULIA KUSTUSCH ” Practice Location

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