Provider Demographics
NPI:1548494107
Name:GREEN, JULIE ANN (SLP)
Entity type:Individual
Prefix:
First Name:JULIE
Middle Name:ANN
Last Name:GREEN
Suffix:
Gender:F
Credentials:SLP
Other - Prefix:
Other - First Name:JULIE
Other - Middle Name:
Other - Last Name:ROGALA
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:SLP
Mailing Address - Street 1:10307 CASA PALARMO DR
Mailing Address - Street 2:
Mailing Address - City:RIVERVIEW
Mailing Address - State:FL
Mailing Address - Zip Code:33578-3549
Mailing Address - Country:US
Mailing Address - Phone:847-814-9253
Mailing Address - Fax:
Practice Address - Street 1:8254 118TH AVENUE NORTH
Practice Address - Street 2:SUITE 100
Practice Address - City:LARGO
Practice Address - State:FL
Practice Address - Zip Code:33773
Practice Address - Country:US
Practice Address - Phone:727-541-5304
Practice Address - Fax:727-546-8527
Is Sole Proprietor?:Yes
Enumeration Date:2009-05-12
Last Update Date:2022-07-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
2355S0801X
CASA156272355S0801X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2355S0801XSpeech, Language and Hearing Service ProvidersSpecialist/TechnologistSpeech-Language Assistant