Provider Demographics
NPI:1720117393
Name:CARRICO, JULIE A (SLP)
Entity type:Individual
Prefix:
First Name:JULIE
Middle Name:A
Last Name:CARRICO
Suffix:
Gender:F
Credentials:SLP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:7307 RIDGE KNOLL DR
Mailing Address - Street 2:
Mailing Address - City:FORT WAYNE
Mailing Address - State:IN
Mailing Address - Zip Code:46804-1419
Mailing Address - Country:US
Mailing Address - Phone:260-432-4033
Mailing Address - Fax:877-829-6676
Practice Address - Street 1:7307 RIDGE KNOLL DR
Practice Address - Street 2:
Practice Address - City:FORT WAYNE
Practice Address - State:IN
Practice Address - Zip Code:46804-1419
Practice Address - Country:US
Practice Address - Phone:260-432-4033
Practice Address - Fax:877-829-6676
Is Sole Proprietor?:No
Enumeration Date:2007-03-02
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN22002985235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist