Provider Demographics
NPI:1285437194
Name:DENNISSON, JULIA PEARL
Entity type:Individual
Prefix:
First Name:JULIA
Middle Name:PEARL
Last Name:DENNISSON
Suffix:
Gender:
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3705 ELLISON RD NW STE B1
Mailing Address - Street 2:
Mailing Address - City:ALBUQUERQUE
Mailing Address - State:NM
Mailing Address - Zip Code:87114-7015
Mailing Address - Country:US
Mailing Address - Phone:608-436-9977
Mailing Address - Fax:608-436-9977
Practice Address - Street 1:5012 GRANDE DR NW
Practice Address - Street 2:
Practice Address - City:ALBUQUERQUE
Practice Address - State:NM
Practice Address - Zip Code:87107-3306
Practice Address - Country:US
Practice Address - Phone:608-436-9977
Practice Address - Fax:608-436-9977
Is Sole Proprietor?:No
Enumeration Date:2025-03-28
Last Update Date:2025-03-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106S00000XBehavioral Health & Social Service ProvidersBehavior Technician