MEDICARE: JULIA BURROUGHS TACY 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
1	235Z00000X	Speech-Language Pathologist	SP.14013	OH

General Provider Information

NPI Number	:	1720692072
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	JULIA BURROUGHS TACY CCC-SLP

Provider Business Mailing Address
First Line	:	6619 COLERIDGE AVE
Second Line	:
City	:	CINCINNATI
State	:	OH
Zip	:	45213-1936
Country	:	US
Telephone Number	:	513-746-5546
Fax Number	:

Provider Business Practice Location Address
First Line	:	7672 LESOURDSVILLE WEST CHESTER RD
Second Line	:
City	:	WEST CHESTER
State	:	OH
Zip	:	45069-1233
Country	:	US
Telephone Number	:	513-777-2201
Fax Number	:

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

Provider Enumeration Date	:	09/03/2020
Last Update Date	:	01/19/2022

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Directions to “ JULIA BURROUGHS TACY CCC-SLP” Practice Location

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