Provider Demographics
NPI:1063987634
Name:PANIGHETTI, JULIENNE N
Entity type:Individual
Prefix:
First Name:JULIENNE
Middle Name:N
Last Name:PANIGHETTI
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 1:20225 BOTHELL EVERETT HWY APT 837
Mailing Address - Street 2:
Mailing Address - City:BOTHELL
Mailing Address - State:WA
Mailing Address - Zip Code:98012-8184
Mailing Address - Country:US
Mailing Address - Phone:732-500-5929
Mailing Address - Fax:
Practice Address - Street 1:13940 NE 166TH ST
Practice Address - Street 2:
Practice Address - City:WOODINVILLE
Practice Address - State:WA
Practice Address - Zip Code:98072-9085
Practice Address - Country:US
Practice Address - Phone:732-500-5929
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2018-10-09
Last Update Date:2018-10-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WACB60817945106S00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106S00000XBehavioral Health & Social Service ProvidersBehavior Technician