Provider Demographics
NPI:1316925779
Name:MINICH, JULIE ANN (MAT CCC SLP)
Entity type:Individual
Prefix:MRS
First Name:JULIE
Middle Name:ANN
Last Name:MINICH
Suffix:
Gender:F
Credentials:MAT CCC SLP
Other - Prefix:MISS
Other - First Name:JULIE
Other - Middle Name:ANN
Other - Last Name:JOHNSON
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:5214 S EAST ST
Mailing Address - Street 2:BUILDING D STE 1
Mailing Address - City:INDIANAPOLIS
Mailing Address - State:IN
Mailing Address - Zip Code:46227
Mailing Address - Country:US
Mailing Address - Phone:800-486-4449
Mailing Address - Fax:317-780-3745
Practice Address - Street 1:5214 S EAST ST
Practice Address - Street 2:BUILDING D STE 1
Practice Address - City:INDIANAPOLIS
Practice Address - State:IN
Practice Address - Zip Code:46227
Practice Address - Country:US
Practice Address - Phone:800-486-4449
Practice Address - Fax:317-780-3745
Is Sole Proprietor?:Not Answered
Enumeration Date:2006-01-05
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN22002931A235Z00000X
KYKY2389235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist