Provider Demographics
NPI:1295281996
Name:JAMESON, JULIE S (EDS)
Entity type:Individual
Prefix:
First Name:JULIE
Middle Name:S
Last Name:JAMESON
Suffix:
Gender:F
Credentials:EDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:17181 HIDDEN POINT DR
Mailing Address - Street 2:
Mailing Address - City:CHAGRIN FALLS
Mailing Address - State:OH
Mailing Address - Zip Code:44023-2001
Mailing Address - Country:US
Mailing Address - Phone:970-214-0070
Mailing Address - Fax:
Practice Address - Street 1:12000 MAPLE LEAF DR
Practice Address - Street 2:
Practice Address - City:GARFIELD HEIGHTS
Practice Address - State:OH
Practice Address - Zip Code:44125-4346
Practice Address - Country:US
Practice Address - Phone:216-475-8105
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2016-09-01
Last Update Date:2016-09-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OHOH3227757103TS0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TS0200XBehavioral Health & Social Service ProvidersPsychologistSchool