Provider Demographics
NPI:1063167120
Name:JULANDER, KRYSTINE CATHERYN
Entity type:Individual
Prefix:
First Name:KRYSTINE
Middle Name:CATHERYN
Last Name:JULANDER
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:KRYSTINE
Other - Middle Name:CATHERYN
Other - Last Name:COLLINS
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:4705 N 26TH LN
Mailing Address - Street 2:
Mailing Address - City:PHOENIX
Mailing Address - State:AZ
Mailing Address - Zip Code:85017-3609
Mailing Address - Country:US
Mailing Address - Phone:602-638-9874
Mailing Address - Fax:
Practice Address - Street 1:7220 W JEFFERSON AVE STE 100
Practice Address - Street 2:
Practice Address - City:LAKEWOOD
Practice Address - State:CO
Practice Address - Zip Code:80235-2015
Practice Address - Country:US
Practice Address - Phone:703-564-1639
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2022-02-17
Last Update Date:2022-02-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZ106S00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106S00000XBehavioral Health & Social Service ProvidersBehavior Technician