Provider Demographics
NPI:1316640105
Name:LACHANCE, JULIA ROSE (CCC-SLP)
Entity type:Individual
Prefix:
First Name:JULIA
Middle Name:ROSE
Last Name:LACHANCE
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 1:92 LAMB ST APT 1
Mailing Address - Street 2:
Mailing Address - City:WESTBROOK
Mailing Address - State:ME
Mailing Address - Zip Code:04092-4285
Mailing Address - Country:US
Mailing Address - Phone:413-519-1915
Mailing Address - Fax:
Practice Address - Street 1:1250 FOREST AVE STE 301
Practice Address - Street 2:
Practice Address - City:PORTLAND
Practice Address - State:ME
Practice Address - Zip Code:04103-1884
Practice Address - Country:US
Practice Address - Phone:413-519-1915
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2023-03-22
Last Update Date:2023-03-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MESP3841235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language PathologistGroup - Single Specialty