Provider Demographics
NPI:1083758379
Name:REILLY, JULIE M (LISW)
Entity Type:Individual
Prefix:
First Name:JULIE
Middle Name:M
Last Name:REILLY
Suffix:
Gender:F
Credentials:LISW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1523 S BLUFF BLVD
Mailing Address - Street 2:
Mailing Address - City:CLINTON
Mailing Address - State:IA
Mailing Address - Zip Code:52732-6549
Mailing Address - Country:US
Mailing Address - Phone:563-243-6054
Mailing Address - Fax:563-243-6828
Practice Address - Street 1:1523 S BLUFF BLVD
Practice Address - Street 2:
Practice Address - City:CLINTON
Practice Address - State:IA
Practice Address - Zip Code:52732-6549
Practice Address - Country:US
Practice Address - Phone:563-243-6054
Practice Address - Fax:563-243-6828
Is Sole Proprietor?:Yes
Enumeration Date:2007-02-19
Last Update Date:2007-07-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IA00652104100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes104100000XBehavioral Health & Social Service ProvidersSocial Worker
Provider Identifiers
StateIdentifier IDID TypeIssuer
IA247041Medicare UPIN
IA52016-01Medicare UPIN
IA39469Medicare UPIN
IA549437Medicare UPIN