MEDICARE: MRS. JULIE MARY TERESE GILL MA

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	103TS0200X	School Psychologist	3328572	AZ

General Provider Information

NPI Number	:	1033346689
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MRS. JULIE MARY TERESE GILL MA

Provider Business Mailing Address
First Line	:	19871 W FREMONT
Second Line	:
City	:	BUCKEYE
State	:	AZ
Zip	:	85326-9512
Country	:	US
Telephone Number	:	623-327-2940
Fax Number	:

Provider Business Practice Location Address
First Line	:	19871 W FREMONT
Second Line	:
City	:	BUCKEYE
State	:	AZ
Zip	:	85326-9512
Country	:	US
Telephone Number	:	623-327-2940
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	06/22/2009
Last Update Date	:	06/22/2009

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