MEDICARE: JULIE SIMENSKY PHD

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	103G00000X	Clinical Neuropsychologist	6053	OH
2	103TR0400X	Rehabilitation Psychologist	6053	OH
3	103T00000X	Psychologist	6053	OH

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1538172283
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	JULIE SIMENSKY PHD

Provider Business Mailing Address
First Line	:	4870 W CLARK RD STE 106
Second Line	:
City	:	YPSILANTI
State	:	MI
Zip	:	48197-1104
Country	:	US
Telephone Number	:	734-961-7196
Fax Number	:	734-961-7187

Provider Business Practice Location Address
First Line	:	4870 W CLARK RD STE 106
Second Line	:
City	:	YPSILANTI
State	:	MI
Zip	:	48197-1104
Country	:	US
Telephone Number	:	734-961-7196
Fax Number	:	734-961-7196

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

Provider Enumeration Date	:	08/14/2006
Last Update Date	:	02/02/2021

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Directions to “ JULIE SIMENSKY PHD” Practice Location

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