Basic Information
| Provider Information | |||||||||
| NPI: | 1598070369 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | ROSKAMP | ||||||||
| FirstName: | JULIA | ||||||||
| MiddleName: | M | ||||||||
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| Credential: | M.A, FAAA | ||||||||
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| Mailing Information | |||||||||
| Address1: | 1090 NE GATEWAY CT NE | ||||||||
| Address2: | SUITE 101 | ||||||||
| City: | CONCORD | ||||||||
| State: | NC | ||||||||
| PostalCode: | 280252414 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7044039100 | ||||||||
| FaxNumber: | 7044039101 | ||||||||
| Practice Location | |||||||||
| Address1: | 1090 NE GATEWAY CT NE | ||||||||
| Address2: | SUITE 101 | ||||||||
| City: | CONCORD | ||||||||
| State: | NC | ||||||||
| PostalCode: | 280252414 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7044039100 | ||||||||
| FaxNumber: | 7044039104 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 08/17/2010 | ||||||||
| LastUpdateDate: | 06/25/2013 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 231H00000X | 8315 | NC | N | Speech, Language and Hearing Service Providers | Audiologist | 237600000X | 1398 | NC | Y | Speech, Language and Hearing Service Providers | Audiologist-Hearing Aid Fitter |
ID Information
| ID | Type | State | Issuer | Description | 7200395 | 05 | NC | MEDICAID |