Provider Demographics
NPI:1043233844
Name:WILDMAN, JULIE J (PHD)
Entity Type:Individual
Prefix:DR
First Name:JULIE
Middle Name:J
Last Name:WILDMAN
Suffix:
Gender:F
Credentials:PHD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3401 ENGINEER LANE
Mailing Address - Street 2:116B
Mailing Address - City:SEASIDE
Mailing Address - State:CA
Mailing Address - Zip Code:93955-7200
Mailing Address - Country:US
Mailing Address - Phone:831-883-3800
Mailing Address - Fax:831-883-3808
Practice Address - Street 1:3401 ENGINEER LN
Practice Address - Street 2:116B
Practice Address - City:SEASIDE
Practice Address - State:CA
Practice Address - Zip Code:93955-7200
Practice Address - Country:US
Practice Address - Phone:831-883-3800
Practice Address - Fax:831-883-3808
Is Sole Proprietor?:Yes
Enumeration Date:2006-07-25
Last Update Date:2007-12-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TNP1981103TC1900X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC1900XBehavioral Health & Social Service ProvidersPsychologistCounseling