Healthcare Provider Details

I. General information

NPI: 1992628705
Provider Name (Legal Business Name): JULIA NEZWORSKI
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/30/2026
Last Update Date: 07/30/2026
Certification Date: 07/30/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1610 E SUNSHINE ST
SPRINGFIELD MO
65804-1313
US

IV. Provider business mailing address

1053 E LAKEWOOD ST
SPRINGFIELD MO
65810-2451
US

V. Phone/Fax

Practice location:
  • Phone: 417-523-7500
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code235Z00000X
TaxonomySpeech-Language Pathologist
License Number2026017382
License Number StateMO

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: