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General NPI Number Information
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NPI Number | 1184099848
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Entity Type | Individual
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Provider Name | JULIE BASCOM
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Gender | Female
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Dates
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Enumeration Date | 12/07/2015
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Last Update Date | 12/07/2015
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Provider Practice Location Address
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Address Line | 24 OLD ETNA RD
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City | LEBANON
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State | NH
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Zip | 03766-1937
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Country | US
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Telephone | 603-443-9875
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Fax |
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Provider Business Mailing Address
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Address Line | 47 VT ROUTE 14 N
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City | EAST RANDOLPH
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State | VT
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Zip | 05041-9523
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Country | US
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Telephone |
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 235Z00000X
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Taxonomy Name | Speech-Language Pathologist
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License Number | 8021582
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License Number State | VT
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