Provider Demographics
NPI:1487731915
Name:CONCANNON, JULIA (MED)
Entity type:Individual
Prefix:MS
First Name:JULIA
Middle Name:
Last Name:CONCANNON
Suffix:
Gender:F
Credentials:MED
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5 N MEADOWS RD
Mailing Address - Street 2:SLP ASSOCIATES, PC
Mailing Address - City:MEDFIELD
Mailing Address - State:MA
Mailing Address - Zip Code:02052-2317
Mailing Address - Country:US
Mailing Address - Phone:508-359-4532
Mailing Address - Fax:508-359-0198
Practice Address - Street 1:5 N MEADOWS RD
Practice Address - Street 2:SLP ASSOCIATES, PC
Practice Address - City:MEDFIELD
Practice Address - State:MA
Practice Address - Zip Code:02052-2317
Practice Address - Country:US
Practice Address - Phone:508-359-4532
Practice Address - Fax:508-359-0198
Is Sole Proprietor?:No
Enumeration Date:2006-11-01
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA2150235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist
Provider Identifiers
StateIdentifier IDID TypeIssuer
MA620733OtherTUFTS GROUP
MASP0065OtherBCBS SPEECH PATHOLOGIST
MA626557OtherHPHC
469967OtherTUFTS INDIVIDUAL
MA1942270574OtherGROUP NPI
MA3668706OtherAETNA
MASG0013OtherBSBS GROUP
MA620733OtherTUFTS GROUP