Healthcare Provider Details

I. General information

NPI: 1720647282
Provider Name (Legal Business Name): JULIANA LYNN HIRN CCC-SLP
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/10/2019
Last Update Date: 10/16/2020
Certification Date: 10/16/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3349 STONEBRIDGE TRL
VALRICO FL
33596-9232
US

IV. Provider business mailing address

3349 STONEBRIDGE TRL
VALRICO FL
33596-9232
US

V. Phone/Fax

Practice location:
  • Phone: 813-727-2050
  • Fax: 855-232-8604
Mailing address:
  • Phone: 137-272-0508
  • Fax: 855-232-8604

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code235Z00000X
TaxonomySpeech-Language Pathologist
License NumberSP.13891
License Number StateOH
# 2
Primary TaxonomyN
Taxonomy Code235Z00000X
TaxonomySpeech-Language Pathologist
License NumberSZ9054
License Number StateFL
# 3
Primary TaxonomyY
Taxonomy Code235Z00000X
TaxonomySpeech-Language Pathologist
License NumberSLP011251
License Number StateGA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: