Provider Demographics
NPI:1770931644
Name:BAYAN, JULANI K (MSED, SAC, CCDVC)
Entity type:Individual
Prefix:MR
First Name:JULANI
Middle Name:K
Last Name:BAYAN
Suffix:
Gender:M
Credentials:MSED, SAC, CCDVC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:201 N. PINE STREET
Mailing Address - Street 2:
Mailing Address - City:BURLINGTON
Mailing Address - State:WI
Mailing Address - Zip Code:53105-1935
Mailing Address - Country:US
Mailing Address - Phone:262-767-0441
Mailing Address - Fax:262-767-9072
Practice Address - Street 1:201 N. PINE STREET
Practice Address - Street 2:
Practice Address - City:BURLINGTON
Practice Address - State:WI
Practice Address - Zip Code:53105-1935
Practice Address - Country:US
Practice Address - Phone:262-767-0441
Practice Address - Fax:262-767-9072
Is Sole Proprietor?:No
Enumeration Date:2016-06-01
Last Update Date:2016-06-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI15556-131101YA0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)