Provider Demographics
NPI:1205558863
Name:GALL, JULIE PATRICIA (LICSW)
Entity type:Individual
Prefix:
First Name:JULIE
Middle Name:PATRICIA
Last Name:GALL
Suffix:
Gender:F
Credentials:LICSW
Other - Prefix:
Other - First Name:JULIE
Other - Middle Name:PATRICIA
Other - Last Name:BAIN
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:LCSW
Mailing Address - Street 1:27209 SE 13TH PL
Mailing Address - Street 2:
Mailing Address - City:SAMMAMISH
Mailing Address - State:WA
Mailing Address - Zip Code:98075-5961
Mailing Address - Country:US
Mailing Address - Phone:408-205-2171
Mailing Address - Fax:
Practice Address - Street 1:8226 BRACKEN PL SE STE 200
Practice Address - Street 2:
Practice Address - City:SNOQUALMIE
Practice Address - State:WA
Practice Address - Zip Code:98065-2935
Practice Address - Country:US
Practice Address - Phone:425-842-3910
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2022-09-12
Last Update Date:2022-09-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WALW000091721041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
WALW00009172OtherSOCIAL WORKER INDEPENDENT CLINICAL LICENSE