Healthcare Provider Details

I. General information

NPI: 1821086943
Provider Name (Legal Business Name): JULIA ELLEN RADEMACHER M.A., M.M., CCC-SLP
Entity Type: Individual
Gender: Female
Sole Proprietor: X

II. Dates (important events)

Enumeration Date: 10/12/2005
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

200 S JORDAN AVE DEPARTMENT OF SPEECH AND HEARING SCIENCES
BLOOMINGTON IN
47405-7002
US

IV. Provider business mailing address

200 S JORDAN AVE DEPARTMENT OF SPEECH AND HEARING SCIENCES
BLOOMINGTON IN
47405-7002
US

V. Phone/Fax

Practice location:
  • Phone: 812-856-4727
  • Fax: 812-855-5561
Mailing address:
  • Phone: 812-856-4727
  • Fax: 812-855-5561

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code235Z00000X
TaxonomySpeech-Language Pathologist
License Number22003308A
License Number StateIN

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: