Basic Information
Provider Information
NPI: 1033557087
EntityType: 1
ReplacementNPI:  
OrganizationName:  
LastName: SHLEIFER
FirstName: JULIANNA
MiddleName:  
NamePrefix:  
NameSuffix:  
Credential: MS, CCC-SLP
OtherOrganizationName:  
OtherOrganizationType:  
OtherLastName:  
OtherFirstName:  
OtherMiddleName:  
OtherNamePrefix:  
OtherNameSuffix:  
OtherCredential:  
OtherLastNameType:  
Mailing Information
Address1: 102 LAKEFRONT DR
Address2:  
City: HUNT VALLEY
State: MD
PostalCode: 210302215
CountryCode: US
TelephoneNumber: 4107853845
FaxNumber:  
Practice Location
Address1: 102 LAKEFRONT DR
Address2:  
City: HUNT VALLEY
State: MD
PostalCode: 210302215
CountryCode: US
TelephoneNumber: 4107853845
FaxNumber:  
Other Information
ProviderEnumerationDate: 06/12/2013
LastUpdateDate: 06/12/2013
NPIDeactivationReasonCode:  
NPIDeactivationDate:  
NPIReactivationDate:  
ProviderGenderCode: F
AuthorizedOfficialLastName:  
AuthorizedOfficialFirstName:  
AuthorizedOfficialMiddleName:  
AuthorizedOfficialTitleorPosition:  
AuthorizedOfficialTelephone:  
IsSoleProprietor: N
IsOrganizationSubpart:  
ParentOrganizationLBN:  
AuthorizedOfficialNamePrefix:  
AuthorizedOfficialNameSuffix:  
AuthorizedOfficialCredential:  

Taxonomy Information
TaxonomyLicenseStateSwitchTaxonomyGroupTaxonomyTypeTaxonomyClassSubSpecialty
235Z00000X07178MDY Speech, Language and Hearing Service ProvidersSpeech-Language Pathologist 

No ID Information.


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