Provider Demographics
NPI:1720427537
Name:JOHNSON, JULIE LYNN (BA, IBCLC)
Entity Type:Individual
Prefix:
First Name:JULIE
Middle Name:LYNN
Last Name:JOHNSON
Suffix:
Gender:F
Credentials:BA, IBCLC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:9857 S WESTLEY PARK CIR
Mailing Address - Street 2:
Mailing Address - City:SOUTH JORDAN
Mailing Address - State:UT
Mailing Address - Zip Code:84095-3018
Mailing Address - Country:US
Mailing Address - Phone:801-608-8947
Mailing Address - Fax:
Practice Address - Street 1:4500 SOUTH 495 EAST
Practice Address - Street 2:#104
Practice Address - City:MURRAY
Practice Address - State:UT
Practice Address - Zip Code:84107
Practice Address - Country:US
Practice Address - Phone:801-608-8947
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2013-06-14
Last Update Date:2013-06-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes174N00000XOther Service ProvidersLactation Consultant, Non-RN
No174H00000XOther Service ProvidersHealth Educator