Provider Demographics
NPI:1528511896
Name:BRISCOE, JULIA (MA, CCC-SLP)
Entity type:Individual
Prefix:MISS
First Name:JULIA
Middle Name:
Last Name:BRISCOE
Suffix:
Gender:F
Credentials:MA, CCC-SLP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:900 HOMEFIELD BLVD
Mailing Address - Street 2:
Mailing Address - City:O FALLON
Mailing Address - State:MO
Mailing Address - Zip Code:63366-4482
Mailing Address - Country:US
Mailing Address - Phone:636-379-4911
Mailing Address - Fax:
Practice Address - Street 1:900 HOMEFIELD BLVD
Practice Address - Street 2:
Practice Address - City:O FALLON
Practice Address - State:MO
Practice Address - Zip Code:63366-4482
Practice Address - Country:US
Practice Address - Phone:636-379-4911
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2016-08-03
Last Update Date:2016-08-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MO2016028065235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist