Basic Information
| Provider Information | |||||||||
| NPI: | 1558581579 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | BANASIAK | ||||||||
| FirstName: | JULIE | ||||||||
| MiddleName: | V | ||||||||
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| Mailing Information | |||||||||
| Address1: | 527 NW EMBER WAY | ||||||||
| Address2: | |||||||||
| City: | JENSEN BEACH | ||||||||
| State: | FL | ||||||||
| PostalCode: | 349573521 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7722329515 | ||||||||
| FaxNumber: | 7722329521 | ||||||||
| Practice Location | |||||||||
| Address1: | 3496 NW FEDERAL HWY STE G | ||||||||
| Address2: | |||||||||
| City: | JENSEN BEACH | ||||||||
| State: | FL | ||||||||
| PostalCode: | 349574441 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7722235945 | ||||||||
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| Other Information | |||||||||
| ProviderEnumerationDate: | 05/01/2007 | ||||||||
| LastUpdateDate: | 07/09/2007 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | Y | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 235Z00000X | SA 6855 | FL | Y | Speech, Language and Hearing Service Providers | Speech-Language Pathologist |
No ID Information.