Healthcare Provider Details

I. General information

NPI: 1154877355
Provider Name (Legal Business Name): JULIA LYNN EARL
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: JULIA LYNN VANDERBILT

II. Dates (important events)

Enumeration Date: 08/28/2016
Last Update Date: 05/26/2026
Certification Date: 05/26/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

20887 WOODMONT
HARPER WOODS MI
48225-1813
US

IV. Provider business mailing address

20887 WOODMONT ST
HARPER WOODS MI
48225-1813
US

V. Phone/Fax

Practice location:
  • Phone: 313-330-1691
  • Fax:
Mailing address:
  • Phone: 313-330-1691
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code103K00000X
TaxonomyBehavior Analyst
License Number7401001469
License Number StateMI
# 2
Primary TaxonomyY
Taxonomy Code247200000X
TaxonomyOther Technician
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: