Provider Demographics
NPI:1609973064
Name:SHIFFLER, JULIE B (PHD)
Entity Type:Individual
Prefix:DR
First Name:JULIE
Middle Name:B
Last Name:SHIFFLER
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 1:2404 N 3000 W
Mailing Address - Street 2:
Mailing Address - City:REXBURG
Mailing Address - State:ID
Mailing Address - Zip Code:83440-3126
Mailing Address - Country:US
Mailing Address - Phone:208-208-6690
Mailing Address - Fax:208-496-1238
Practice Address - Street 1:2404 N 3000 W
Practice Address - Street 2:
Practice Address - City:REXBURG
Practice Address - State:ID
Practice Address - Zip Code:83440-3126
Practice Address - Country:US
Practice Address - Phone:208-208-6690
Practice Address - Fax:208-496-1238
Is Sole Proprietor?:Yes
Enumeration Date:2006-09-20
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IDPSY-378103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical