Provider Demographics
NPI:1063997849
Name:MEDENWALD, JULIE ANNE
Entity type:Individual
Prefix:
First Name:JULIE
Middle Name:ANNE
Last Name:MEDENWALD
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1690 MILWAUKEE ST
Mailing Address - Street 2:STE 101
Mailing Address - City:DENVER
Mailing Address - State:CO
Mailing Address - Zip Code:80206-1627
Mailing Address - Country:US
Mailing Address - Phone:303-504-9945
Mailing Address - Fax:
Practice Address - Street 1:5750 DTC PKWY STE 170
Practice Address - Street 2:
Practice Address - City:GREENWOOD VILLAGE
Practice Address - State:CO
Practice Address - Zip Code:80111-5483
Practice Address - Country:US
Practice Address - Phone:303-504-9945
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2018-09-27
Last Update Date:2022-01-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
COPSLP.0000401235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist