Provider Demographics
NPI:1427501311
Name:ENSER, JULIA TUTTLE (MED, CCC-SLP)
Entity type:Individual
Prefix:
First Name:JULIA
Middle Name:TUTTLE
Last Name:ENSER
Suffix:
Gender:F
Credentials:MED, CCC-SLP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:176 W WOODSIDE AVE
Mailing Address - Street 2:
Mailing Address - City:BUFFALO
Mailing Address - State:NY
Mailing Address - Zip Code:14220-2160
Mailing Address - Country:US
Mailing Address - Phone:585-489-6113
Mailing Address - Fax:
Practice Address - Street 1:646 E DELAVAN AVE
Practice Address - Street 2:
Practice Address - City:BUFFALO
Practice Address - State:NY
Practice Address - Zip Code:14215-3012
Practice Address - Country:US
Practice Address - Phone:716-816-3294
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2016-07-27
Last Update Date:2024-04-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY028107235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist