MEDICARE: JULIE SCHWALENBERG BCBA

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	103K00000X	Behavior Analyst	1-18-31168
2	103K00000X	Behavior Analyst

General Provider Information

NPI Number	:	1417401514
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	JULIE SCHWALENBERG BCBA

Provider Business Mailing Address
First Line	:	1363 DOUGLAS DR STE 104
Second Line	:
City	:	TRAVERSE CITY
State	:	MI
Zip	:	49696-8980
Country	:	US
Telephone Number	:	231-668-4909
Fax Number	:	231-943-1334

Provider Business Practice Location Address
First Line	:	1363 DOUGLAS DR STE 104
Second Line	:
City	:	TRAVERSE CITY
State	:	MI
Zip	:	49696-8980
Country	:	US
Telephone Number	:	231-668-4909
Fax Number	:	231-943-1334

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	08/08/2016
Last Update Date	:	07/12/2023

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