Provider Demographics
NPI:1588692065
Name:JUELICH, PAULA M (PHD)
Entity type:Individual
Prefix:
First Name:PAULA
Middle Name:M
Last Name:JUELICH
Suffix:
Gender:F
Credentials:PHD
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Mailing Address - Street 1:1836 LACKLAND HILL PKWY
Mailing Address - Street 2:ATTNT: CREDENTIALING DEPT.
Mailing Address - City:SAINT LOUIS
Mailing Address - State:MO
Mailing Address - Zip Code:63146-3572
Mailing Address - Country:US
Mailing Address - Phone:314-989-0300
Mailing Address - Fax:314-810-1399
Practice Address - Street 1:6420 CLAYTON RD
Practice Address - Street 2:6TH FLOOR
Practice Address - City:SAINT LOUIS
Practice Address - State:MO
Practice Address - Zip Code:63117-1811
Practice Address - Country:US
Practice Address - Phone:314-768-5205
Practice Address - Fax:314-768-5315
Is Sole Proprietor?:No
Enumeration Date:2006-06-30
Last Update Date:2007-10-19
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Provider Licenses
StateLicense IDTaxonomies
MO2003030080103TC0700X, 103G00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103G00000XBehavioral Health & Social Service ProvidersClinical Neuropsychologist
No103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical