Provider Demographics
NPI:1962438309
Name:AHLQUIST TANNER, JULIA ALICE (AUD)
Entity type:Individual
Prefix:
First Name:JULIA
Middle Name:ALICE
Last Name:AHLQUIST TANNER
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 1:650 UNIVERSITY AVENUE
Mailing Address - Street 2:SUITE 108
Mailing Address - City:SACRAMENTO
Mailing Address - State:CA
Mailing Address - Zip Code:95825-6726
Mailing Address - Country:US
Mailing Address - Phone:916-646-2471
Mailing Address - Fax:916-646-2472
Practice Address - Street 1:650 UNIVERSITY AVENUE
Practice Address - Street 2:SUITE 108
Practice Address - City:SACRAMENTO
Practice Address - State:CA
Practice Address - Zip Code:95825-6726
Practice Address - Country:US
Practice Address - Phone:916-646-2471
Practice Address - Fax:916-646-2472
Is Sole Proprietor?:Yes
Enumeration Date:2006-06-25
Last Update Date:2016-01-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAAU2675231H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes231H00000XSpeech, Language and Hearing Service ProvidersAudiologist