Provider Demographics
NPI:1760683387
Name:DESJARDINS, JULIE ANNE (BC-MT, NMT)
Entity Type:Individual
Prefix:
First Name:JULIE
Middle Name:ANNE
Last Name:DESJARDINS
Suffix:
Gender:F
Credentials:BC-MT, NMT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:26850 FORLI AVE
Mailing Address - Street 2:
Mailing Address - City:WYOMING
Mailing Address - State:MN
Mailing Address - Zip Code:55092-9265
Mailing Address - Country:US
Mailing Address - Phone:651-270-6031
Mailing Address - Fax:651-462-3076
Practice Address - Street 1:26850 FORLI AVE
Practice Address - Street 2:
Practice Address - City:WYOMING
Practice Address - State:MN
Practice Address - Zip Code:55092-9265
Practice Address - Country:US
Practice Address - Phone:651-270-6031
Practice Address - Fax:651-462-3076
Is Sole Proprietor?:Yes
Enumeration Date:2007-05-30
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
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Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225A00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMusic Therapist