Provider Demographics
NPI:1477329266
Name:PECK, JULIA GRACE (BA)
Entity Type:Individual
Prefix:MRS
First Name:JULIA
Middle Name:GRACE
Last Name:PECK
Suffix:
Gender:F
Credentials:BA
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Mailing Address - Street 1:4420 E JORY ST APT 309
Mailing Address - Street 2:
Mailing Address - City:NEWBERG
Mailing Address - State:OR
Mailing Address - Zip Code:97132-3661
Mailing Address - Country:US
Mailing Address - Phone:503-812-7975
Mailing Address - Fax:
Practice Address - Street 1:1827 NE 44TH AVE STE 390
Practice Address - Street 2:
Practice Address - City:PORTLAND
Practice Address - State:OR
Practice Address - Zip Code:97213-1461
Practice Address - Country:US
Practice Address - Phone:503-963-6494
Practice Address - Fax:310-933-4134
Is Sole Proprietor?:No
Enumeration Date:2023-12-01
Last Update Date:2023-12-01
Deactivation Date:
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Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106S00000XBehavioral Health & Social Service ProvidersBehavior Technician