Provider Demographics
NPI:1861875106
Name:MORTENSON, JULIE (MS,)
Entity type:Individual
Prefix:
First Name:JULIE
Middle Name:
Last Name:MORTENSON
Suffix:
Gender:F
Credentials:MS,
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3120 S RAINBOW BLVD
Mailing Address - Street 2:SUITE 202
Mailing Address - City:LAS VEGAS
Mailing Address - State:NV
Mailing Address - Zip Code:89146-6236
Mailing Address - Country:US
Mailing Address - Phone:702-233-4327
Mailing Address - Fax:702-233-8837
Practice Address - Street 1:3120 S RAINBOW BLVD
Practice Address - Street 2:SUITE 202
Practice Address - City:LAS VEGAS
Practice Address - State:NV
Practice Address - Zip Code:89146-6236
Practice Address - Country:US
Practice Address - Phone:702-233-4327
Practice Address - Fax:702-233-8837
Is Sole Proprietor?:Yes
Enumeration Date:2015-07-06
Last Update Date:2015-07-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NVA-1640231H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes231H00000XSpeech, Language and Hearing Service ProvidersAudiologist