Healthcare Provider Details

I. General information

NPI: 1609414952
Provider Name (Legal Business Name): JULIA MARIE BRUCKNER-GRILL
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 12/17/2019
Last Update Date: 05/20/2026
Certification Date: 05/20/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1701 CURVE CREST BLVD W STE 104
STILLWATER MN
55082-6181
US

IV. Provider business mailing address

1701 CURVE CREST BLVD W STE 104
STILLWATER MN
55082-6181
US

V. Phone/Fax

Practice location:
  • Phone: 651-342-1883
  • Fax:
Mailing address:
  • Phone: 651-342-1883
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code103K00000X
TaxonomyBehavior Analyst
License Number0522
License Number StateMN

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: