Provider Demographics
NPI:1255681839
Name:WALLACE, JULIE SCHROEDER (PHD)
Entity Type:Individual
Prefix:DR
First Name:JULIE
Middle Name:SCHROEDER
Last Name:WALLACE
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 1:1701 NW 193RD CIR
Mailing Address - Street 2:
Mailing Address - City:EDMOND
Mailing Address - State:OK
Mailing Address - Zip Code:73012-3553
Mailing Address - Country:US
Mailing Address - Phone:405-740-8800
Mailing Address - Fax:405-657-2556
Practice Address - Street 1:4334 NW EXPRESSWAY
Practice Address - Street 2:SUITE 102
Practice Address - City:OKLAHOMA CITY
Practice Address - State:OK
Practice Address - Zip Code:73116-1515
Practice Address - Country:US
Practice Address - Phone:405-740-8800
Practice Address - Fax:405-657-2556
Is Sole Proprietor?:Yes
Enumeration Date:2012-09-11
Last Update Date:2016-02-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OK823103T00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103T00000XBehavioral Health & Social Service ProvidersPsychologist