Provider Demographics
NPI:1063690725
Name:CORMACK, JULIANA H (MA, CCC-A)
Entity type:Individual
Prefix:MRS
First Name:JULIANA
Middle Name:H
Last Name:CORMACK
Suffix:
Gender:F
Credentials:MA, CCC-A
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1322 N INTERSTATE DR
Mailing Address - Street 2:
Mailing Address - City:NORMAN
Mailing Address - State:OK
Mailing Address - Zip Code:73072-3393
Mailing Address - Country:US
Mailing Address - Phone:405-307-0670
Mailing Address - Fax:405-307-0679
Practice Address - Street 1:1322 N INTERSTATE DR
Practice Address - Street 2:
Practice Address - City:NORMAN
Practice Address - State:OK
Practice Address - Zip Code:73072-3393
Practice Address - Country:US
Practice Address - Phone:405-307-0670
Practice Address - Fax:405-307-0679
Is Sole Proprietor?:No
Enumeration Date:2008-02-05
Last Update Date:2012-10-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OK309231H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes231H00000XSpeech, Language and Hearing Service ProvidersAudiologist