Healthcare Provider Details

I. General information

NPI: 1245408715
Provider Name (Legal Business Name): JULIA MATTEK MSCCC-SLP
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

Provider Other Name: JULIA WECKMUELLER MSCCC-SLP

II. Dates (important events)

Enumeration Date: 02/18/2008
Last Update Date: 11/29/2011
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

6700 N. PORT WASHINGTON RD. C/O ST. FRANCIS CHILDREN'S CENTER
GLENDALE WI
53217-3919
US

IV. Provider business mailing address

6700 N. PORT WASHINGTON RD. C/O ST. FRANCIS CHILDREN'S CENTER
GLENDALE WI
53217-3919
US

V. Phone/Fax

Practice location:
  • Phone: 414-351-8850
  • Fax: 414-351-8846
Mailing address:
  • Phone: 414-351-8850
  • Fax: 414-351-8846

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code235Z00000X
TaxonomySpeech-Language Pathologist
License Number3047154
License Number StateWI
# 2
Primary TaxonomyY
Taxonomy Code235Z00000X
TaxonomySpeech-Language Pathologist
License Number3047-154
License Number StateWI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: