Provider Demographics
NPI:1073049789
Name:THOMPSON, JULIANN (PHD)
Entity Type:Individual
Prefix:
First Name:JULIANN
Middle Name:
Last Name:THOMPSON
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 1:99-128 AIEA HEIGHTS DR STE 305
Mailing Address - Street 2:
Mailing Address - City:AIEA
Mailing Address - State:HI
Mailing Address - Zip Code:96701-3933
Mailing Address - Country:US
Mailing Address - Phone:310-896-5254
Mailing Address - Fax:
Practice Address - Street 1:99-128 AIEA HEIGHTS DR STE 305
Practice Address - Street 2:
Practice Address - City:AIEA
Practice Address - State:HI
Practice Address - Zip Code:96701-3933
Practice Address - Country:US
Practice Address - Phone:310-896-5254
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2017-05-02
Last Update Date:2020-10-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
HIPSY-1863103G00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103G00000XBehavioral Health & Social Service ProvidersClinical Neuropsychologist