Provider Demographics
NPI:1215108477
Name:JUNE, AUDRY L (MS CCC SLP)
Entity type:Individual
Prefix:MRS
First Name:AUDRY
Middle Name:L
Last Name:JUNE
Suffix:
Gender:F
Credentials:MS 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:PO BOX 918
Mailing Address - Street 2:15 UTHE BLVD
Mailing Address - City:COEYMANS
Mailing Address - State:NY
Mailing Address - Zip Code:12045
Mailing Address - Country:US
Mailing Address - Phone:518-756-7285
Mailing Address - Fax:
Practice Address - Street 1:15 UTHE BLVD
Practice Address - Street 2:
Practice Address - City:COEYMANS
Practice Address - State:NY
Practice Address - Zip Code:12045
Practice Address - Country:US
Practice Address - Phone:518-756-7285
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2008-03-17
Last Update Date:2008-03-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
0077271235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist