Provider Demographics
NPI:1316493984
Name:ENGLERT, JULIE (PSYD)
Entity type:Individual
Prefix:DR
First Name:JULIE
Middle Name:
Last Name:ENGLERT
Suffix:
Gender:F
Credentials:PSYD
Other - Prefix:DR
Other - First Name:JULIE
Other - Middle Name:
Other - Last Name:DEDERER
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:PSYD
Mailing Address - Street 1:3406 ALDER AVENUE
Mailing Address - Street 2:
Mailing Address - City:FT. WAINWRIGHT
Mailing Address - State:AK
Mailing Address - Zip Code:99703
Mailing Address - Country:US
Mailing Address - Phone:907-353-4126
Mailing Address - Fax:
Practice Address - Street 1:3406 ALDER AVENUE
Practice Address - Street 2:
Practice Address - City:FT. WAINWRIGHT
Practice Address - State:AK
Practice Address - Zip Code:99703
Practice Address - Country:US
Practice Address - Phone:907-353-4126
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2016-09-01
Last Update Date:2020-04-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WY652103TC0700X
390200000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical
No390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program