Healthcare Provider Details

I. General information

NPI: 1477066678
Provider Name (Legal Business Name): JULIE LYNN HALL
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 11/09/2017
Last Update Date: 06/29/2023
Certification Date: 06/29/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

510 WHISPERING WIND DR STE 110
TRACY CA
95377-8119
US

IV. Provider business mailing address

651 S STOCKTON AVE
RIPON CA
95366-2749
US

V. Phone/Fax

Practice location:
  • Phone: 209-832-7756
  • Fax:
Mailing address:
  • Phone: 209-649-8962
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code103K00000X
TaxonomyBehavior Analyst
License Number1-18-30980
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: