Provider Demographics
NPI:1437488962
Name:JULIEN, JACQUELINE BRIGETTE (PSYD, LP)
Entity Type:Individual
Prefix:DR
First Name:JACQUELINE
Middle Name:BRIGETTE
Last Name:JULIEN
Suffix:
Gender:F
Credentials:PSYD, LP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:640 ATLANTIC AVE
Mailing Address - Street 2:
Mailing Address - City:BENSON
Mailing Address - State:MN
Mailing Address - Zip Code:56215-1381
Mailing Address - Country:US
Mailing Address - Phone:320-843-3454
Mailing Address - Fax:
Practice Address - Street 1:640 ATLANTIC AVE
Practice Address - Street 2:
Practice Address - City:BENSON
Practice Address - State:MN
Practice Address - Zip Code:56215-1381
Practice Address - Country:US
Practice Address - Phone:320-843-3454
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2009-12-11
Last Update Date:2009-12-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MNLP#4865103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical