Provider Demographics
NPI:1306547013
Name:MONCEAUX-VISSER, JULIANNE L (MS CCC-SLP)
Entity type:Individual
Prefix:
First Name:JULIANNE
Middle Name:L
Last Name:MONCEAUX-VISSER
Suffix:
Gender:F
Credentials:MS CCC-SLP
Other - Prefix:
Other - First Name:JULIANNE
Other - Middle Name:L
Other - Last Name:MONCEAUX
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:3709 S BROADWAY UNIT 101
Mailing Address - Street 2:
Mailing Address - City:ALEXANDRIA
Mailing Address - State:MN
Mailing Address - Zip Code:56308-3497
Mailing Address - Country:US
Mailing Address - Phone:320-808-1067
Mailing Address - Fax:
Practice Address - Street 1:12020 PACIFIC ST
Practice Address - Street 2:
Practice Address - City:OMAHA
Practice Address - State:NE
Practice Address - Zip Code:68154-3507
Practice Address - Country:US
Practice Address - Phone:218-255-0524
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2023-03-10
Last Update Date:2023-03-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VT144.0134586235Z00000X
MN518256235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist