Provider Demographics
NPI:1093828204
Name:THEISMANN, JULIE KAY
Entity Type:Individual
Prefix:MS
First Name:JULIE
Middle Name:KAY
Last Name:THEISMANN
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:JULIE
Other - Middle Name:KAY
Other - Last Name:HULLERMAN
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:2025 STEARNS WAY
Mailing Address - Street 2:
Mailing Address - City:SAINT CLOUD
Mailing Address - State:MN
Mailing Address - Zip Code:56303-4491
Mailing Address - Country:US
Mailing Address - Phone:320-253-3540
Mailing Address - Fax:320-253-1475
Practice Address - Street 1:2025 STEARNS WAY STE 111
Practice Address - Street 2:
Practice Address - City:SAINT CLOUD
Practice Address - State:MN
Practice Address - Zip Code:56303-1275
Practice Address - Country:US
Practice Address - Phone:320-253-3540
Practice Address - Fax:320-253-1475
Is Sole Proprietor?:No
Enumeration Date:2006-08-15
Last Update Date:2007-12-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MN061941041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical