Provider Demographics
NPI:1447041306
Name:WALL, JULIE ANNE (CMPSS)
Entity type:Individual
Prefix:MRS
First Name:JULIE
Middle Name:ANNE
Last Name:WALL
Suffix:
Gender:F
Credentials:CMPSS
Other - Prefix:MISS
Other - First Name:JULIE
Other - Middle Name:ANNE
Other - Last Name:WOOD
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:CMPSS
Mailing Address - Street 1:1213 ELM TERRACE WAY
Mailing Address - Street 2:
Mailing Address - City:WHEATLAND
Mailing Address - State:CA
Mailing Address - Zip Code:95692-9315
Mailing Address - Country:US
Mailing Address - Phone:831-212-1935
Mailing Address - Fax:
Practice Address - Street 1:505 M ST
Practice Address - Street 2:
Practice Address - City:RIO LINDA
Practice Address - State:CA
Practice Address - Zip Code:95673-2218
Practice Address - Country:US
Practice Address - Phone:831-212-1935
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2025-05-13
Last Update Date:2025-05-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAMPSS-LCXHGA175T00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes175T00000XOther Service ProvidersPeer Specialist