Individual
JULIANNA LANE
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Contact information
Practice address
620 PONGALA RD, TIETON, WA 98947-9534
(630) 479-9390
Mailing address
620 PONGALA RD, TIETON, WA 98947-9534
(630) 479-9390
Taxonomy
Speciality
Code
Description
License number
State
101YM0800X
Mental Health Counselor
—
—
1041C0700X
Clinical Social Worker
Primary
10371624-3501
UT
Other
Enumeration date
06/06/2019
Last updated
06/29/2025
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