Healthcare Provider Details

I. General information

NPI: 1225523368
Provider Name (Legal Business Name): JULIE POMERLEAU PH.D.
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/29/2018
Last Update Date: 05/13/2022
Certification Date: 05/13/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3454 OAK ALLEY CT STE 510
TOLEDO OH
43606-5526
US

IV. Provider business mailing address

3454 OAK ALLEY CT STE 510
TOLEDO OH
43606-5526
US

V. Phone/Fax

Practice location:
  • Phone: 567-218-0185
  • Fax: 419-930-6721
Mailing address:
  • Phone: 567-218-0185
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code103T00000X
TaxonomyPsychologist
License NumberP.08240
License Number StateOH
# 2
Primary TaxonomyN
Taxonomy Code390200000X
TaxonomyStudent in an Organized Health Care Education/Training Program
License Number
License Number StateNULL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: