Healthcare Provider Details

I. General information

NPI: 1033775994
Provider Name (Legal Business Name): JULIA BARRETTE CCC-SLP
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/16/2019
Last Update Date: 10/18/2022
Certification Date: 10/18/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2835 W SAINT GERMAIN ST STE 300
SAINT CLOUD MN
56301-6281
US

IV. Provider business mailing address

2835 W SAINT GERMAIN ST STE 300
SAINT CLOUD MN
56301-6281
US

V. Phone/Fax

Practice location:
  • Phone: 320-259-4151
  • Fax: 320-259-5707
Mailing address:
  • Phone: 320-259-4151
  • Fax: 320-259-5707

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code235Z00000X
TaxonomySpeech-Language Pathologist
License Number14181119
License Number StateMN

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: