1699089458 NPI number — MS. JULIE DAWN WALKER JONES LCPC

Table of content: MS. JULIE DAWN WALKER JONES LCPC (NPI 1699089458)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1699089458 NPI number — MS. JULIE DAWN WALKER JONES LCPC

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
WALKER JONES
Provider First Name:
JULIE
Provider Middle Name:
DAWN
Provider Name Prefix Text:
MS.
Provider Name Suffix Text:
Provider Credential Text:
LCPC
Provider Gender Code:
F

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1699089458
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
04/22/2020
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
1090 W PARK PL
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
COEUR D ALENE
Provider Business Mailing Address State Name:
ID
Provider Business Mailing Address Postal Code:
83814-2785
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
208-292-0303
Provider Business Mailing Address Fax Number:

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
2005 N IRONWOOD PKWY STE 120
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
COEUR D ALENE
Provider Business Practice Location Address State Name:
ID
Provider Business Practice Location Address Postal Code:
83814-2647
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
208-818-1099
Provider Business Practice Location Address Fax Number:
208-924-4444
Provider Enumeration Date:
08/03/2010

Additional Information

Authorized Official

Authorized Official Last Name:
Authorized Official First Name:
Authorized Official Middle Name:
Authorized Official Title or Position:
Authorized Official Telephone Number:

Provider Taxonomy Codes

  • Taxonomy code: 101YP2500X , with the licence number:  LCPC-5078 , registered in the state of ID ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)

  • Identifier: 1699089458 , issued by the state of ( ID ) . This identifiers is of the category "MEDICAID".




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