Provider Demographics
NPI:1740736305
Name:VORMITTAG, JULIA MARIE (MA, RBT)
Entity Type:Individual
Prefix:MRS
First Name:JULIA
Middle Name:MARIE
Last Name:VORMITTAG
Suffix:
Gender:F
Credentials:MA, RBT
Other - Prefix:MS
Other - First Name:JULIA
Other - Middle Name:MARIE
Other - Last Name:MEDINA
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:BS, RBT
Mailing Address - Street 1:1428 44TH ST SW
Mailing Address - Street 2:
Mailing Address - City:WYOMING
Mailing Address - State:MI
Mailing Address - Zip Code:49509
Mailing Address - Country:US
Mailing Address - Phone:616-604-8492
Mailing Address - Fax:
Practice Address - Street 1:1428 44TH ST SW
Practice Address - Street 2:
Practice Address - City:WYOMING
Practice Address - State:MI
Practice Address - Zip Code:49509
Practice Address - Country:US
Practice Address - Phone:616-604-8492
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2016-09-01
Last Update Date:2016-09-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103K00000XBehavioral Health & Social Service ProvidersBehavior Analyst