Healthcare Provider Details

I. General information

NPI: 1043469919
Provider Name (Legal Business Name): JULIE ANNE SNAPPER
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

Provider Other Name: JULIE ANNE LODGE

II. Dates (important events)

Enumeration Date: 09/16/2008
Last Update Date: 09/16/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

19322 WATERBURY LN
HUNTINGTON BEACH CA
92646-2739
US

IV. Provider business mailing address

19322 WATERBURY LN
HUNTINGTON BEACH CA
92646-2739
US

V. Phone/Fax

Practice location:
  • Phone: 714-742-1459
  • Fax:
Mailing address:
  • Phone: 714-742-1459
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code235Z00000X
TaxonomySpeech-Language Pathologist
License NumberSP9552
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: