Healthcare Provider Details

I. General information

NPI: 1437488962
Provider Name (Legal Business Name): JACQUELINE BRIGETTE JULIEN PSY.D., L.P.
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 12/11/2009
Last Update Date: 12/11/2009
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

640 ATLANTIC AVE
BENSON MN
56215-1381
US

IV. Provider business mailing address

640 ATLANTIC AVE
BENSON MN
56215-1381
US

V. Phone/Fax

Practice location:
  • Phone: 320-843-3454
  • Fax:
Mailing address:
  • Phone: 320-843-3454
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code103TC0700X
TaxonomyClinical Psychologist
License NumberLP#4865
License Number StateMN

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: