Provider Demographics
NPI:1730354721
Name:HERTZ, JULIE PAIGE (CCC/SLP)
Entity type:Individual
Prefix:MRS
First Name:JULIE
Middle Name:PAIGE
Last Name:HERTZ
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 1:9290 MAXWELLS XING
Mailing Address - Street 2:
Mailing Address - City:DAYTON
Mailing Address - State:OH
Mailing Address - Zip Code:45458-5030
Mailing Address - Country:US
Mailing Address - Phone:352-317-2622
Mailing Address - Fax:352-317-2622
Practice Address - Street 1:9290 MAXWELLS XING
Practice Address - Street 2:
Practice Address - City:DAYTON
Practice Address - State:OH
Practice Address - Zip Code:45458-5030
Practice Address - Country:US
Practice Address - Phone:352-317-2622
Practice Address - Fax:352-317-2622
Is Sole Proprietor?:Yes
Enumeration Date:2008-04-29
Last Update Date:2021-02-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLSA8551235Z00000X
OHSP12728235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist
Provider Identifiers
StateIdentifier IDID TypeIssuer
OHAB7360731OtherMEDICARE PIN
OH2187155Medicaid