MEDICARE: JULIE M LESPERANCE, PSY.D., PLLC

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	103TC0700X	Clinical Psychologist
2	103T00000X	Psychologist	4629	AZ

General Provider Information

NPI Number	:	1073962148
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	JULIE M LESPERANCE, PSY.D., PLLC

Provider Business Mailing Address
First Line	:	PO BOX 1784
Second Line	:
City	:	PORT ANGELES
State	:	WA
Zip	:	98362-0094
Country	:	US
Telephone Number	:	360-460-7360
Fax Number	:	844-254-6908

Provider Business Practice Location Address
First Line	:	204 CREEKSIDE DR
Second Line	:
City	:	PORT ANGELES
State	:	WA
Zip	:	98362-3011
Country	:	US
Telephone Number	:	360-460-7360
Fax Number	:	844-254-6908

Authorized Official
Title or Position	:	CLINICAL PSYCHOLOGIST
Name	:	JULIE MARIE LESPERANCE
Credential	:	PSYD
Telephone Number	:	360-460-7360

Provider Enumeration Date	:	06/08/2016
Last Update Date	:	06/25/2026

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