Healthcare Provider Details

I. General information

NPI: 1154873974
Provider Name (Legal Business Name): JULIE IRWIN
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 10/27/2016
Last Update Date: 08/07/2024
Certification Date: 08/07/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

801 N 11TH ST
SAINT LOUIS MO
63101-1015
US

IV. Provider business mailing address

65 TARPON DR
SEA GIRT NJ
08750-2212
US

V. Phone/Fax

Practice location:
  • Phone: 314-633-5300
  • Fax:
Mailing address:
  • Phone: 551-206-6092
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

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

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: