Provider Demographics
NPI:1801949979
Name:DE JONGE, JULIA BERNICE (PHD)
Entity type:Individual
Prefix:DR
First Name:JULIA
Middle Name:BERNICE
Last Name:DE JONGE
Suffix:
Gender:F
Credentials:PHD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4469 CASCADE RD SE
Mailing Address - Street 2:SUITE 4469
Mailing Address - City:GRAND RAPIDS
Mailing Address - State:MI
Mailing Address - Zip Code:49546-3632
Mailing Address - Country:US
Mailing Address - Phone:616-940-3331
Mailing Address - Fax:
Practice Address - Street 1:4469 CASCADE RD SE
Practice Address - Street 2:SUITE 4469
Practice Address - City:GRAND RAPIDS
Practice Address - State:MI
Practice Address - Zip Code:49546-3632
Practice Address - Country:US
Practice Address - Phone:616-940-3331
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-01-19
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI1816731103T00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103T00000XBehavioral Health & Social Service ProvidersPsychologist