Healthcare Provider Details

I. General information

NPI: 1922421684
Provider Name (Legal Business Name): MS. JULIANNE RUTH PARKER
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 01/30/2014
Last Update Date: 01/30/2014
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

14775 AUBURN RD
NEWBURY OH
44065-9702
US

IV. Provider business mailing address

125 HUNTINGTON ST
CHARDON OH
44024-1226
US

V. Phone/Fax

Practice location:
  • Phone: 440-564-2282
  • Fax: 440-564-9690
Mailing address:
  • Phone: 440-564-2282
  • Fax: 440-564-9690

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code235Z00000X
TaxonomySpeech-Language Pathologist
License NumberSP.7126
License Number StateOH

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: