Provider Demographics
NPI:1023160587
Name:CAJOLET-ECKHARDT, JULIE ANN (PSYD)
Entity type:Individual
Prefix:DR
First Name:JULIE
Middle Name:ANN
Last Name:CAJOLET-ECKHARDT
Suffix:
Gender:F
Credentials:PSYD
Other - Prefix:DR
Other - First Name:JULIE
Other - Middle Name:ANN
Other - Last Name:CAJOLET
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:PSYD
Mailing Address - Street 1:3048 E BASELINE RD
Mailing Address - Street 2:SUITE 107
Mailing Address - City:MESA
Mailing Address - State:AZ
Mailing Address - Zip Code:85204-7286
Mailing Address - Country:US
Mailing Address - Phone:323-475-8543
Mailing Address - Fax:602-293-3271
Practice Address - Street 1:3048 E BASELINE RD
Practice Address - Street 2:SUITE 107
Practice Address - City:MESA
Practice Address - State:AZ
Practice Address - Zip Code:85204-7286
Practice Address - Country:US
Practice Address - Phone:323-475-8543
Practice Address - Fax:602-293-3271
Is Sole Proprietor?:No
Enumeration Date:2007-01-17
Last Update Date:2014-12-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI2801-057103T00000X
AZ4561103T00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103T00000XBehavioral Health & Social Service ProvidersPsychologist
Provider Identifiers
StateIdentifier IDID TypeIssuer
WI43702600Medicaid