Provider Demographics
NPI:1528214053
Name:SANDBERG, JULIE LYNN
Entity Type:Individual
Prefix:MRS
First Name:JULIE
Middle Name:LYNN
Last Name:SANDBERG
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 1:3057 BRIW RD
Mailing Address - Street 2:
Mailing Address - City:PLACERVILLE
Mailing Address - State:CA
Mailing Address - Zip Code:95667-5321
Mailing Address - Country:US
Mailing Address - Phone:530-642-4878
Mailing Address - Fax:530-295-8307
Practice Address - Street 1:3057 BRIW RD
Practice Address - Street 2:
Practice Address - City:PLACERVILLE
Practice Address - State:CA
Practice Address - Zip Code:95667-5321
Practice Address - Country:US
Practice Address - Phone:530-642-4878
Practice Address - Fax:530-295-8307
Is Sole Proprietor?:No
Enumeration Date:2008-08-15
Last Update Date:2008-08-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional