Provider Demographics
NPI:1962400036
Name:BRETON, JULIE PERRY (AUD)
Entity type:Individual
Prefix:DR
First Name:JULIE
Middle Name:PERRY
Last Name:BRETON
Suffix:
Gender:F
Credentials:AUD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:824 OAK ST
Mailing Address - Street 2:SUITE 102
Mailing Address - City:BROCKTON
Mailing Address - State:MA
Mailing Address - Zip Code:02301-1180
Mailing Address - Country:US
Mailing Address - Phone:508-559-9200
Mailing Address - Fax:508-559-0027
Practice Address - Street 1:824 OAK ST
Practice Address - Street 2:SUITE 102
Practice Address - City:BROCKTON
Practice Address - State:MA
Practice Address - Zip Code:02301-1180
Practice Address - Country:US
Practice Address - Phone:508-559-9200
Practice Address - Fax:508-559-0027
Is Sole Proprietor?:Not Answered
Enumeration Date:2005-07-12
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA160231H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes231H00000XSpeech, Language and Hearing Service ProvidersAudiologist
Provider Identifiers
StateIdentifier IDID TypeIssuer
MA680470OtherTUFTS
MA5102294Medicaid
MAAD0008OtherBLUE CROSS BLUE SHIELD
PE012364Medicare ID - Type Unspecified