Provider Demographics
NPI:1184818262
Name:KOCAL, JULIA LYNN (PSYD)
Entity Type:Individual
Prefix:DR
First Name:JULIA
Middle Name:LYNN
Last Name:KOCAL
Suffix:
Gender:F
Credentials:PSYD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:225 WEXFORD RD
Mailing Address - Street 2:
Mailing Address - City:VALPARAISO
Mailing Address - State:IN
Mailing Address - Zip Code:46385-8040
Mailing Address - Country:US
Mailing Address - Phone:219-531-2877
Mailing Address - Fax:219-531-2891
Practice Address - Street 1:225 WEXFORD RD
Practice Address - Street 2:
Practice Address - City:VALPARAISO
Practice Address - State:IN
Practice Address - Zip Code:46385-8040
Practice Address - Country:US
Practice Address - Phone:219-531-2877
Practice Address - Fax:219-531-2891
Is Sole Proprietor?:Yes
Enumeration Date:2007-08-31
Last Update Date:2020-09-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN20042194A103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
IN255460Medicare PIN