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NPI Code Detail

MEDICARE: JULIE A GREEN MA, CCC-SLP

MEDICARE: JULIE A GREEN MA, CCC-SLP
Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

# Taxonomy Code Taxonomy License Number License Number State
1235Z00000XSpeech-Language PathologistSP#2252AR

Other Identifiers

# Provider Identifier Provider Identifier Type Provider Identifier State Provider Identifier Issuer
15Y523OTHERARBLUE CROSS BLUE SHIELD #

General Provider Information

NPI Number : 1578511531
Entity Type Code : Individual
Provider Name (Legal Business Name) : JULIE A GREEN MA, CCC-SLP
Provider Business Mailing Address
First Line : 551 BEASLEY DR
Second Line :
City : CENTERTON
State : AR
Zip : 72719-9481
Country : US
Telephone Number :
Fax Number :
Provider Business Practice Location Address
First Line : 1760 N WOODLAND AVE
Second Line : ELIZABETH RICHARDSON CENTER
City : FAYETTEVILLE
State : AR
Zip : 72703-2549
Country : US
Telephone Number : 479-443-4420
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 05/04/2006
Last Update Date : 07/08/2007

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Directions to “ JULIE A GREEN MA, CCC-SLP” Practice Location

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