Healthcare Provider Details

I. General information

NPI: 1154816932
Provider Name (Legal Business Name): JULIANNE M DYNNESON
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/25/2018
Last Update Date: 06/25/2018
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

6021 244TH ST SW # 400
MOUNTLAKE TERRACE WA
98043-5400
US

IV. Provider business mailing address

4832 35TH AVE SW
SEATTLE WA
98126-2710
US

V. Phone/Fax

Practice location:
  • Phone: 425-245-9940
  • Fax: 855-490-1545
Mailing address:
  • Phone: 206-773-5189
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code106S00000X
TaxonomyBehavior Technician
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: