Provider Demographics
NPI:1104172337
Name:BUDKE, JULIE ANNE (MS, CCC-SLP)
Entity type:Individual
Prefix:MS
First Name:JULIE
Middle Name:ANNE
Last Name:BUDKE
Suffix:
Gender:F
Credentials:MS, CCC-SLP
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Other - First Name:
Other - Middle Name:
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Mailing Address - Street 1:3965 W 83RD STREET SUITE 233
Mailing Address - Street 2:
Mailing Address - City:PRAIRIE VILLAGE
Mailing Address - State:KS
Mailing Address - Zip Code:66208
Mailing Address - Country:US
Mailing Address - Phone:913-789-9170
Mailing Address - Fax:913-789-9170
Practice Address - Street 1:3965 W 83RD STREET SUITE 233
Practice Address - Street 2:
Practice Address - City:PRAIRIE VILLAGE
Practice Address - State:KS
Practice Address - Zip Code:66208
Practice Address - Country:US
Practice Address - Phone:913-789-9170
Practice Address - Fax:913-789-9170
Is Sole Proprietor?:No
Enumeration Date:2012-07-25
Last Update Date:2012-07-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KSA-046-196103TR0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TR0400XBehavioral Health & Social Service ProvidersPsychologistRehabilitation