Provider Demographics
NPI:1790234888
Name:BRANDT, JULIE A A (PHD)
Entity Type:Individual
Prefix:
First Name:JULIE
Middle Name:A A
Last Name:BRANDT
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 1:1477 S KNOWLES AVE STE 103
Mailing Address - Street 2:
Mailing Address - City:NEW RICHMOND
Mailing Address - State:WI
Mailing Address - Zip Code:54017-2543
Mailing Address - Country:US
Mailing Address - Phone:715-246-9762
Mailing Address - Fax:
Practice Address - Street 1:1477 S KNOWLES AVE STE 103
Practice Address - Street 2:
Practice Address - City:NEW RICHMOND
Practice Address - State:WI
Practice Address - Zip Code:54017-2543
Practice Address - Country:US
Practice Address - Phone:715-246-9762
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2016-09-29
Last Update Date:2016-09-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI157-140390200000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program