Provider Demographics
NPI:1114493533
Name:THOMAS-LOTTERMAN, JULIE
Entity Type:Individual
Prefix:
First Name:JULIE
Middle Name:
Last Name:THOMAS-LOTTERMAN
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 1:600 N FAIRBANKS CT UNIT 2507
Mailing Address - Street 2:
Mailing Address - City:CHICAGO
Mailing Address - State:IL
Mailing Address - Zip Code:60611-5856
Mailing Address - Country:US
Mailing Address - Phone:734-717-8764
Mailing Address - Fax:
Practice Address - Street 1:1416 W BELMONT AVE
Practice Address - Street 2:
Practice Address - City:CHICAGO
Practice Address - State:IL
Practice Address - Zip Code:60657-0939
Practice Address - Country:US
Practice Address - Phone:734-717-8764
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2018-10-24
Last Update Date:2018-10-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL178.014235101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional
Provider Identifiers
StateIdentifier IDID TypeIssuer
IL178014235OtherLPC LICENSE