Provider Demographics
NPI:1083045892
Name:GALLAGHER, JULIE LOUISE (MS, RD, LD)
Entity Type:Individual
Prefix:MS
First Name:JULIE
Middle Name:LOUISE
Last Name:GALLAGHER
Suffix:
Gender:F
Credentials:MS, RD, LD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3285 CROSSPARK RD.
Mailing Address - Street 2:
Mailing Address - City:CORALVILLE
Mailing Address - State:IA
Mailing Address - Zip Code:52241
Mailing Address - Country:US
Mailing Address - Phone:319-665-2220
Mailing Address - Fax:319-665-2408
Practice Address - Street 1:1720 WATERFRONT DRIVE
Practice Address - Street 2:
Practice Address - City:IOWA CITY
Practice Address - State:IA
Practice Address - Zip Code:52240
Practice Address - Country:US
Practice Address - Phone:319-354-7601
Practice Address - Fax:319-354-7025
Is Sole Proprietor?:Yes
Enumeration Date:2013-12-04
Last Update Date:2018-10-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IA01330133V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes133V00000XDietary & Nutritional Service ProvidersDietitian, Registered