Provider Demographics
NPI:1992525521
Name:GOTKIN, JULIA SAGE (CCC-SLP)
Entity type:Individual
Prefix:
First Name:JULIA
Middle Name:SAGE
Last Name:GOTKIN
Suffix:
Gender:F
Credentials:CCC-SLP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:15 LANSDALE RD
Mailing Address - Street 2:
Mailing Address - City:NEW CITY
Mailing Address - State:NY
Mailing Address - Zip Code:10956-4101
Mailing Address - Country:US
Mailing Address - Phone:845-558-6513
Mailing Address - Fax:
Practice Address - Street 1:2200 AQUEDUCT AVE E
Practice Address - Street 2:
Practice Address - City:BRONX
Practice Address - State:NY
Practice Address - Zip Code:10453-1400
Practice Address - Country:US
Practice Address - Phone:718-584-5805
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2024-10-17
Last Update Date:2024-10-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY034831235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist