Healthcare Provider Details

I. General information

NPI: 1720126998
Provider Name (Legal Business Name): JULIANE N COMPTON MS, CCC-SLP
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 02/01/2007
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1422 SAN MARCO BLVD
JACKSONVILLE FL
32207-8536
US

IV. Provider business mailing address

13700 SUTTON PARK DR N APT 1418
JACKSONVILLE FL
32224-2273
US

V. Phone/Fax

Practice location:
  • Phone: 904-398-4133
  • Fax: 904-398-4148
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code235Z00000X
TaxonomySpeech-Language Pathologist
License NumberSA9024
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: