Provider Demographics
NPI:1962218099
Name:MASSA, JULIE ANN (CCC-SLP)
Entity type:Individual
Prefix:
First Name:JULIE ANN
Middle Name:
Last Name:MASSA
Suffix:
Gender:F
Credentials:CCC-SLP
Other - Prefix:
Other - First Name:JULIE
Other - Middle Name:
Other - Last Name:MASSA
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:CCC-SLP
Mailing Address - Street 1:119 MIFFLIN ST
Mailing Address - Street 2:
Mailing Address - City:PHILADELPHIA
Mailing Address - State:PA
Mailing Address - Zip Code:19148-1903
Mailing Address - Country:US
Mailing Address - Phone:908-839-5536
Mailing Address - Fax:
Practice Address - Street 1:119 MIFFLIN ST
Practice Address - Street 2:
Practice Address - City:PHILADELPHIA
Practice Address - State:PA
Practice Address - Zip Code:19148-1903
Practice Address - Country:US
Practice Address - Phone:908-839-5536
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2024-12-04
Last Update Date:2024-12-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PASL015462235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist