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General NPI Number Information
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NPI Number | 1235210865
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Entity Type | Organization
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Legal Business Name | JULIE B. SHIFFLER, PHD, PC
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Dates
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Enumeration Date | 10/18/2006
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Last Update Date | 08/22/2020
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Provider Practice Location Address
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Address Line | 2404 N 3000 W
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City | REXBURG
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State | ID
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Zip | 83440-3126
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Country | US
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Telephone | 208-201-6690
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Fax | 208-496-1238
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Provider Business Mailing Address
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Address Line | 2404 N 3000 W
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City | REXBURG
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State | ID
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Zip | 83440-3126
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Country | US
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Telephone | 208-201-6690
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Fax | 208-496-1238
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Authorized Official
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Title or Position | PRESIDENT
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Name | DR. JULIE B. SHIFFLER
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Credential | PH.D.
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Telephone | 208-201-6690
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 103TC0700X
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Taxonomy Name | Clinical Psychologist
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License Number | PSY-378
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License Number State | ID
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