Healthcare Provider Details

I. General information

NPI: 1942447909
Provider Name (Legal Business Name): JULIE ANN DAGGETT PH.D.
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 01/13/2009
Last Update Date: 01/13/2009
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1411 MARSH ST STE. 104
SAN LUIS OBISPO CA
93401-2957
US

IV. Provider business mailing address

1411 MARSH ST STE. 104
SAN LUIS OBISPO CA
93401-2957
US

V. Phone/Fax

Practice location:
  • Phone: 805-547-1720
  • Fax: 805-547-1720
Mailing address:
  • Phone: 805-547-1720
  • Fax: 805-547-1720

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code103TB0200X
TaxonomyCognitive & Behavioral Psychologist
License NumberPSY18057
License Number StateCA
# 2
Primary TaxonomyY
Taxonomy Code103TC2200X
TaxonomyClinical Child & Adolescent Psychologist
License NumberPSY18057
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: