Healthcare Provider Details

I. General information

NPI: 1932014545
Provider Name (Legal Business Name): JULIE LYNN TABB
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

Provider Other Name: JULIE L TAGLIERI

II. Dates (important events)

Enumeration Date: 08/18/2026
Last Update Date: 08/18/2026
Certification Date: 08/18/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

530 E 34TH ST
JOPLIN MO
64804-3926
US

IV. Provider business mailing address

530 E 34TH ST
JOPLIN MO
64804-3926
US

V. Phone/Fax

Practice location:
  • Phone: 417-347-7630
  • Fax:
Mailing address:
  • Phone: 417-347-7630
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License Number2026036524
License Number StateMO

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: