Healthcare Provider Details

I. General information

NPI: 1639683477
Provider Name (Legal Business Name): JULIE MATHENEY MS, CCC-SLP, CLEC
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 11/30/2017
Last Update Date: 09/09/2026
Certification Date: 09/09/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

715 4TH ST
HERMOSA BEACH CA
90254-4755
US

IV. Provider business mailing address

715 4TH ST
HERMOSA BEACH CA
90254-4755
US

V. Phone/Fax

Practice location:
  • Phone: 424-386-2539
  • Fax:
Mailing address:
  • Phone: 424-386-2539
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code174N00000X
TaxonomyLactation Consultant (Non-RN)
License NumberL-136572
License Number StateCA
# 2
Primary TaxonomyN
Taxonomy Code235Z00000X
TaxonomySpeech-Language Pathologist
License Number20684
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: