Provider Demographics
NPI:1194090332
Name:BOL, JULIE ANN (CCC-SLP)
Entity type:Individual
Prefix:
First Name:JULIE
Middle Name:ANN
Last Name:BOL
Suffix:
Gender:F
Credentials:CCC-SLP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3237 OLD COLONY RD
Mailing Address - Street 2:
Mailing Address - City:KALAMAZOO
Mailing Address - State:MI
Mailing Address - Zip Code:49008-4915
Mailing Address - Country:US
Mailing Address - Phone:269-870-6459
Mailing Address - Fax:269-978-8916
Practice Address - Street 1:6376 QUAIL RUN DR
Practice Address - Street 2:
Practice Address - City:KALAMAZOO
Practice Address - State:MI
Practice Address - Zip Code:49009-2811
Practice Address - Country:US
Practice Address - Phone:269-544-3764
Practice Address - Fax:269-544-3767
Is Sole Proprietor?:Yes
Enumeration Date:2012-03-21
Last Update Date:2012-06-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI12038548235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist