Provider Demographics
NPI:1063057891
Name:BLALACK, JULIA SHEA
Entity type:Individual
Prefix:
First Name:JULIA
Middle Name:SHEA
Last Name:BLALACK
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 1:1375 AKALANI LOOP UNIT C
Mailing Address - Street 2:
Mailing Address - City:KAILUA
Mailing Address - State:HI
Mailing Address - Zip Code:96734
Mailing Address - Country:US
Mailing Address - Phone:361-793-8000
Mailing Address - Fax:
Practice Address - Street 1:203 KAPA'A QUARRY PL. #5002
Practice Address - Street 2:
Practice Address - City:KAILUA.
Practice Address - State:HI
Practice Address - Zip Code:96734
Practice Address - Country:US
Practice Address - Phone:808-247-2973
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2019-11-15
Last Update Date:2019-11-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106S00000XBehavioral Health & Social Service ProvidersBehavior Technician