Provider Demographics
NPI:1043755432
Name:DEVRIES, JULIE
Entity Type:Individual
Prefix:
First Name:JULIE
Middle Name:
Last Name:DEVRIES
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:201 S MARKET ST
Mailing Address - Street 2:PO BOX 458
Mailing Address - City:OTTUMWA
Mailing Address - State:IA
Mailing Address - Zip Code:52501-2924
Mailing Address - Country:US
Mailing Address - Phone:641-684-6896
Mailing Address - Fax:641-226-5759
Practice Address - Street 1:1015 N 18TH ST
Practice Address - Street 2:
Practice Address - City:CENTERVILLE
Practice Address - State:IA
Practice Address - Zip Code:52544-1170
Practice Address - Country:US
Practice Address - Phone:641-856-4400
Practice Address - Fax:641-856-4405
Is Sole Proprietor?:No
Enumeration Date:2016-12-21
Last Update Date:2016-12-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IA084545101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
IA1912952367Medicaid