=====================================================
General NPI Number Information
=====================================================
NPI Number | 1386229102
-----------------------------------------------------
Entity Type | Individual
-----------------------------------------------------
Provider Name | JULIE SMITH M.S. CCC-SLP/TSSLD
-----------------------------------------------------
Gender | Female
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 03/12/2021
-----------------------------------------------------
Last Update Date | 03/12/2021
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 1500 LOCUST ST APT 4002
-----------------------------------------------------
City | PHILADELPHIA
-----------------------------------------------------
State | PA
-----------------------------------------------------
Zip | 19102-4326
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 215-264-4823
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 4537 OLD OAK RD
-----------------------------------------------------
City | DOYLESTOWN
-----------------------------------------------------
State | PA
-----------------------------------------------------
Zip | 18902-8809
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 215-264-4823
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position |
-----------------------------------------------------
Name |
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone |
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 235Z00000X
-----------------------------------------------------
Taxonomy Name | Speech-Language Pathologist
-----------------------------------------------------
License Number | 029250
-----------------------------------------------------
License Number State | NY
-----------------------------------------------------