Provider Demographics
NPI:1285405985
Name:BUCKLEY, JULIA LIGHTHEART
Entity type:Individual
Prefix:MS
First Name:JULIA
Middle Name:LIGHTHEART
Last Name:BUCKLEY
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 1:2700 39TH AVE NE STE A119
Mailing Address - Street 2:
Mailing Address - City:MINNEAPOLIS
Mailing Address - State:MN
Mailing Address - Zip Code:55421-4385
Mailing Address - Country:US
Mailing Address - Phone:612-781-5830
Mailing Address - Fax:
Practice Address - Street 1:2700 39TH AVE NE STE A119
Practice Address - Street 2:
Practice Address - City:MINNEAPOLIS
Practice Address - State:MN
Practice Address - Zip Code:55421-4385
Practice Address - Country:US
Practice Address - Phone:612-781-5830
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2024-01-11
Last Update Date:2024-01-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MN237700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes237700000XSpeech, Language and Hearing Service ProvidersHearing Instrument SpecialistGroup - Single Specialty