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General NPI Number Information
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NPI Number | 1578511531
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Entity Type | Individual
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Provider Name | JULIE A GREEN MA, CCC-SLP
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Gender | Female
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Dates
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Enumeration Date | 05/04/2006
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Last Update Date | 07/08/2007
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Provider Practice Location Address
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Address Line | 1760 N WOODLAND AVE ELIZABETH RICHARDSON CENTER
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City | FAYETTEVILLE
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State | AR
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Zip | 72703-2549
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Country | US
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Telephone | 479-443-4420
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Fax |
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Provider Business Mailing Address
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Address Line | 551 BEASLEY DR
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City | CENTERTON
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State | AR
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Zip | 72719-9481
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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 | SP#2252
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License Number State | AR
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