Provider Demographics
NPI:1609365790
Name:SEGOVIANO, JULIA (CCC-SLP)
Entity type:Individual
Prefix:
First Name:JULIA
Middle Name:
Last Name:SEGOVIANO
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 1:4068 30TH ST
Mailing Address - Street 2:
Mailing Address - City:SAN DIEGO
Mailing Address - State:CA
Mailing Address - Zip Code:92104-2602
Mailing Address - Country:US
Mailing Address - Phone:916-705-2813
Mailing Address - Fax:
Practice Address - Street 1:4068 30TH ST
Practice Address - Street 2:
Practice Address - City:SAN DIEGO
Practice Address - State:CA
Practice Address - Zip Code:92104-2602
Practice Address - Country:US
Practice Address - Phone:916-705-2813
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2018-05-04
Last Update Date:2024-05-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA31231235Z00000X
IL146014682235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist