Healthcare Provider Details

I. General information

NPI: 1972430031
Provider Name (Legal Business Name): JULIE MARIE TITERA
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/05/2026
Last Update Date: 05/05/2026
Certification Date: 05/05/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

755 SCHEURING RD
DE PERE WI
54115-1701
US

IV. Provider business mailing address

W6118 WILD CHERRY CT
MENASHA WI
54952-9766
US

V. Phone/Fax

Practice location:
  • Phone: 920-336-5754
  • Fax: 920-336-2978
Mailing address:
  • Phone: 920-336-5754
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code235Z00000X
TaxonomySpeech-Language Pathologist
License Number1590027191
License Number StateWI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: