Basic Information
Provider Information | |||||||||
NPI: | 1841525011 | ||||||||
EntityType: | 1 | ||||||||
ReplacementNPI: |   | ||||||||
OrganizationName: |   | ||||||||
LastName: | MARSHALL | ||||||||
FirstName: | JULIE | ||||||||
MiddleName: | L. | ||||||||
NamePrefix: | MRS. | ||||||||
NameSuffix: |   | ||||||||
Credential: | CCC-SLP | ||||||||
OtherOrganizationName: |   | ||||||||
OtherOrganizationType: |   | ||||||||
OtherLastName: | MARSHALL | ||||||||
OtherFirstName: | JULIE | ||||||||
OtherMiddleName: | SABLE | ||||||||
OtherNamePrefix: |   | ||||||||
OtherNameSuffix: |   | ||||||||
OtherCredential: | CCC-SLP | ||||||||
OtherLastNameType: | 1 | ||||||||
Mailing Information | |||||||||
Address1: | PO BOX 1000 | ||||||||
Address2: | DEPT 128 | ||||||||
City: | MEMPHIS | ||||||||
State: | TN | ||||||||
PostalCode: | 381480128 | ||||||||
CountryCode: | US | ||||||||
TelephoneNumber: | 9018210338 | ||||||||
FaxNumber: | 9018210384 | ||||||||
Practice Location | |||||||||
Address1: | 807 JEFFERSON AVE | ||||||||
Address2: |   | ||||||||
City: | MEMPHIS | ||||||||
State: | TN | ||||||||
PostalCode: | 381055042 | ||||||||
CountryCode: | US | ||||||||
TelephoneNumber: | 9016785800 | ||||||||
FaxNumber: | 9015251282 | ||||||||
Other Information | |||||||||
ProviderEnumerationDate: | 10/06/2009 | ||||||||
LastUpdateDate: | 06/19/2012 | ||||||||
NPIDeactivationReasonCode: |   | ||||||||
NPIDeactivationDate: |   | ||||||||
NPIReactivationDate: |   | ||||||||
ProviderGenderCode: | F | ||||||||
AuthorizedOfficialLastName: |   | ||||||||
AuthorizedOfficialFirstName: |   | ||||||||
AuthorizedOfficialMiddleName: |   | ||||||||
AuthorizedOfficialTitleorPosition: |   | ||||||||
AuthorizedOfficialTelephone: |   | ||||||||
IsSoleProprietor: | N | ||||||||
IsOrganizationSubpart: |   | ||||||||
ParentOrganizationLBN: |   | ||||||||
AuthorizedOfficialNamePrefix: |   | ||||||||
AuthorizedOfficialNameSuffix: |   | ||||||||
AuthorizedOfficialCredential: |   | ||||||||
NPICertificationDate: |   |
Taxonomy Information
Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 235Z00000X | 000722 | TN | Y |   | Speech, Language and Hearing Service Providers | Speech-Language Pathologist |   |
No ID Information.