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General NPI Number Information
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NPI Number | 1639837842
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Entity Type | Individual
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Provider Name | JULIA DEBRA DETTNER
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Gender | Female
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Dates
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Enumeration Date | 12/05/2021
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Last Update Date | 12/05/2021
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Provider Practice Location Address
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Address Line | 1500 N CLYBOURN AVE UNIT C105
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City | CHICAGO
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State | IL
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Zip | 60610-2295
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Country | US
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Telephone | 312-242-1665
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Fax |
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Provider Business Mailing Address
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Address Line | 1457 N HALSTED ST APT 1102
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City | CHICAGO
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State | IL
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Zip | 60642-2640
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Country | US
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Telephone | 916-320-0577
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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 | 146.016289
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License Number State | IL
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