Provider Demographics
NPI:1356559629
Name:GOODMUNDSON, JULIE MAE (ATR)
Entity type:Individual
Prefix:
First Name:JULIE
Middle Name:MAE
Last Name:GOODMUNDSON
Suffix:
Gender:F
Credentials:ATR
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:17309 BAY CIR
Mailing Address - Street 2:
Mailing Address - City:WAYZATA
Mailing Address - State:MN
Mailing Address - Zip Code:55391-2806
Mailing Address - Country:US
Mailing Address - Phone:612-636-2936
Mailing Address - Fax:
Practice Address - Street 1:17309 BAY CIR
Practice Address - Street 2:
Practice Address - City:WAYZATA
Practice Address - State:MN
Practice Address - Zip Code:55391-2806
Practice Address - Country:US
Practice Address - Phone:612-636-2936
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-05-19
Last Update Date:2018-03-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MN19562255A2300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2255A2300XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersSpecialist/TechnologistAthletic Trainer