Healthcare Provider Details

I. General information

NPI: 1164346219
Provider Name (Legal Business Name): JULIA MATTERN SLP
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: JULIA MATTERN SLP

II. Dates (important events)

Enumeration Date: 08/10/2026
Last Update Date: 08/14/2026
Certification Date: 08/14/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1615 E CAPITOL WAY
BISMARCK ND
58501-2218
US

IV. Provider business mailing address

1615 E CAPITOL WAY
BISMARCK ND
58501-2218
US

V. Phone/Fax

Practice location:
  • Phone: 701-751-0410
  • Fax:
Mailing address:
  • Phone: 701-751-0410
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code235Z00000X
TaxonomySpeech-Language Pathologist
License Number3142
License Number StateND

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: