Provider Demographics
NPI:1992470413
Name:IM, JULIA EDEN DIETSCHE
Entity type:Individual
Prefix:
First Name:JULIA EDEN
Middle Name:DIETSCHE
Last Name:IM
Suffix:
Gender:
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:600A VILLAGE WALK DR
Mailing Address - Street 2:
Mailing Address - City:HOLLY SPRINGS
Mailing Address - State:NC
Mailing Address - Zip Code:27540-4438
Mailing Address - Country:US
Mailing Address - Phone:919-285-2157
Mailing Address - Fax:
Practice Address - Street 1:600A VILLAGE WALK DR
Practice Address - Street 2:
Practice Address - City:HOLLY SPRINGS
Practice Address - State:NC
Practice Address - Zip Code:27540-4438
Practice Address - Country:US
Practice Address - Phone:919-285-2157
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2021-08-16
Last Update Date:2025-04-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC30003874235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist