Provider Demographics
NPI:1407565393
Name:TIDD, JULIA
Entity Type:Individual
Prefix:
First Name:JULIA
Middle Name:
Last Name:TIDD
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4945 STATE ROUTE 339
Mailing Address - Street 2:
Mailing Address - City:VINCENT
Mailing Address - State:OH
Mailing Address - Zip Code:45784-5106
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:4945 STATE ROUTE 339
Practice Address - Street 2:
Practice Address - City:VINCENT
Practice Address - State:OH
Practice Address - Zip Code:45784-5106
Practice Address - Country:US
Practice Address - Phone:740-993-0399
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2022-11-18
Last Update Date:2023-01-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes175T00000XOther Service ProvidersPeer Specialist
No171M00000XOther Service ProvidersCase Manager/Care Coordinator