Provider Demographics
NPI:1902669369
Name:SHANE, JULIA (MS, CF-SLP)
Entity Type:Individual
Prefix:
First Name:JULIA
Middle Name:
Last Name:SHANE
Suffix:
Gender:F
Credentials:MS, CF-SLP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1710 N ST LOWR LEVEL
Mailing Address - Street 2:
Mailing Address - City:OMAHA
Mailing Address - State:NE
Mailing Address - Zip Code:68107-3033
Mailing Address - Country:US
Mailing Address - Phone:402-577-0496
Mailing Address - Fax:
Practice Address - Street 1:1710 N ST LOWR LEVEL
Practice Address - Street 2:
Practice Address - City:OMAHA
Practice Address - State:NE
Practice Address - Zip Code:68107-3033
Practice Address - Country:US
Practice Address - Phone:402-577-0496
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2024-01-30
Last Update Date:2024-01-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NE1000235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist