Healthcare Provider Details

I. General information

NPI: 1790049831
Provider Name (Legal Business Name): JULIA LYNN PHILLIPS REGISTERED
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

Provider Other Name: JULIA LYNN PHILLIPS REGISTERED DIETECHNS

II. Dates (important events)

Enumeration Date: 07/03/2012
Last Update Date: 05/14/2026
Certification Date: 05/14/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

321 BIG ARCH RD
GODFREY IL
62035
US

IV. Provider business mailing address

321 BIG ARCH RD
GODFREY IL
62035-2008
US

V. Phone/Fax

Practice location:
  • Phone: 618-973-5832
  • Fax: 618-433-1556
Mailing address:
  • Phone: 618-973-5832
  • Fax: 618-433-1556

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code136A00000X
TaxonomyRegistered Dietetic Technician
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: