Provider Demographics
NPI:1093518433
Name:MARRIOTT, JULIE MICHELLE (SLP)
Entity type:Individual
Prefix:
First Name:JULIE
Middle Name:MICHELLE
Last Name:MARRIOTT
Suffix:
Gender:
Credentials:SLP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:20215 E 45TH ST STE 307
Mailing Address - Street 2:
Mailing Address - City:BLUE SPRINGS
Mailing Address - State:MO
Mailing Address - Zip Code:64015-4593
Mailing Address - Country:US
Mailing Address - Phone:816-560-4651
Mailing Address - Fax:
Practice Address - Street 1:20215 E 45TH ST STE 307
Practice Address - Street 2:
Practice Address - City:BLUE SPRINGS
Practice Address - State:MO
Practice Address - Zip Code:64015-4593
Practice Address - Country:US
Practice Address - Phone:816-560-4651
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2025-03-31
Last Update Date:2025-03-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KS4065235Z00000X
MO2004018415235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist