Healthcare Provider Details

I. General information

NPI: 1235463373
Provider Name (Legal Business Name): JULIA ANN CRAGUE M.A., CCC-SLP
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

Provider Other Name: JULIA ANN FEATHERSTUN M.A., CCC-SLP

II. Dates (important events)

Enumeration Date: 09/22/2009
Last Update Date: 09/22/2009
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

12999 N PENNSYLVANIA ST
CARMEL IN
46032-5477
US

IV. Provider business mailing address

12999 N PENNSYLVANIA ST
CARMEL IN
46032-5477
US

V. Phone/Fax

Practice location:
  • Phone: 317-848-2448
  • Fax:
Mailing address:
  • Phone: 317-848-2448
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code235Z00000X
TaxonomySpeech-Language Pathologist
License Number220003602A
License Number StateIN

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: