MEDICARE: JULIE A CARRICO 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
1	235Z00000X	Speech-Language Pathologist	22002985	IN

General Provider Information

NPI Number	:	1720117393
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	JULIE A CARRICO SLP

Provider Business Mailing Address
First Line	:	7307 RIDGE KNOLL DR
Second Line	:
City	:	FORT WAYNE
State	:	IN
Zip	:	46804-1419
Country	:	US
Telephone Number	:	260-432-4033
Fax Number	:	877-829-6676

Provider Business Practice Location Address
First Line	:	7307 RIDGE KNOLL DR
Second Line	:
City	:	FORT WAYNE
State	:	IN
Zip	:	46804-1419
Country	:	US
Telephone Number	:	260-432-4033
Fax Number	:	877-829-6676

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	03/02/2007
Last Update Date	:	07/08/2007

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Directions to “ JULIE A CARRICO SLP” Practice Location

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