Healthcare Provider Details

I. General information

NPI: 1942791025
Provider Name (Legal Business Name): MS. MORGANNE ELIZABETH LASLEY JUELICH
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 05/23/2018
Last Update Date: 08/11/2026
Certification Date: 08/11/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

795 WILLOW RD UNIT 332
MENLO PARK CA
94025-2539
US

IV. Provider business mailing address

795 WILLOW RD UNIT 332
MENLO PARK CA
94025-2539
US

V. Phone/Fax

Practice location:
  • Phone: 650-376-8641
  • Fax:
Mailing address:
  • Phone: 650-376-8641
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YA0400X
TaxonomyAddiction (Substance Use Disorder) Counselor
License Number20408
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: