Provider Demographics
NPI:1053895995
Name:BEHRSTOCK, JULIE LYNN (MA)
Entity type:Individual
Prefix:
First Name:JULIE
Middle Name:LYNN
Last Name:BEHRSTOCK
Suffix:
Gender:F
Credentials:MA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:415 N CRESCENT DR STE 360
Mailing Address - Street 2:
Mailing Address - City:BEVERLY HILLS
Mailing Address - State:CA
Mailing Address - Zip Code:90210-6815
Mailing Address - Country:US
Mailing Address - Phone:310-995-4901
Mailing Address - Fax:
Practice Address - Street 1:415 N CRESCENT DR STE 360
Practice Address - Street 2:
Practice Address - City:BEVERLY HILLS
Practice Address - State:CA
Practice Address - Zip Code:90210-6815
Practice Address - Country:US
Practice Address - Phone:310-995-4901
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2018-09-17
Last Update Date:2018-09-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA10854235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language PathologistGroup - Single Specialty