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NPI Code Detail

MEDICARE: JULIA RANDLE

MEDICARE:   JULIA  RANDLE
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
1103TC0700XClinical Psychologist6352001051MI

General Provider Information

NPI Number : 1447193701
Entity Type Code : Individual
Provider Name (Legal Business Name) : JULIA RANDLE
Provider Business Mailing Address
First Line : 1600 ARDMORE ALCOA WAY APT 301
Second Line :
City : LOUISVILLE
State : TN
Zip : 37777-3092
Country : US
Telephone Number :
Fax Number :
Provider Business Practice Location Address
First Line : 4690 FULTON ST E STE 102
Second Line :
City : ADA
State : MI
Zip : 49301-8454
Country : US
Telephone Number : 616-425-7701
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 04/13/2026
Last Update Date : 04/13/2026

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Directions to “ JULIA RANDLE ” Practice Location

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