Provider Demographics
NPI:1114567179
Name:WALLINGFORD, JULIE MAE (MED, BCBA)
Entity type:Individual
Prefix:
First Name:JULIE MAE
Middle Name:
Last Name:WALLINGFORD
Suffix:
Gender:F
Credentials:MED, BCBA
Other - Prefix:
Other - First Name:JULIE
Other - Middle Name:MAE
Other - Last Name:WALLINGFORD
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:
Mailing Address - Street 1:276 SHADOW RUN DR
Mailing Address - Street 2:
Mailing Address - City:SAN JOSE
Mailing Address - State:CA
Mailing Address - Zip Code:95110-3554
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:1054 S DE ANZA BLVD # 105
Practice Address - Street 2:
Practice Address - City:SAN JOSE
Practice Address - State:CA
Practice Address - Zip Code:95129-3553
Practice Address - Country:US
Practice Address - Phone:408-320-5139
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2020-01-08
Last Update Date:2024-04-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103K00000XBehavioral Health & Social Service ProvidersBehavior Analyst