Provider Demographics
NPI:1770063950
Name:PRICE, JULIE
Entity type:Individual
Prefix:
First Name:JULIE
Middle Name:
Last Name:PRICE
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 1525
Mailing Address - Street 2:
Mailing Address - City:PORTSMOUTH
Mailing Address - State:OH
Mailing Address - Zip Code:45662-1525
Mailing Address - Country:US
Mailing Address - Phone:740-354-7545
Mailing Address - Fax:740-351-0567
Practice Address - Street 1:433 3RD ST
Practice Address - Street 2:
Practice Address - City:PORTSMOUTH
Practice Address - State:OH
Practice Address - Zip Code:45662-3811
Practice Address - Country:US
Practice Address - Phone:740-354-7545
Practice Address - Fax:740-351-0567
Is Sole Proprietor?:No
Enumeration Date:2018-08-17
Last Update Date:2021-04-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171M00000XOther Service ProvidersCase Manager/Care Coordinator
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH0310187Medicaid