Provider Demographics
NPI:1154478691
Name:WHITWORTH, JULIE A (MS)
Entity Type:Individual
Prefix:MRS
First Name:JULIE
Middle Name:A
Last Name:WHITWORTH
Suffix:
Gender:F
Credentials:MS
Other - Prefix:MS
Other - First Name:JULIE
Other - Middle Name:A
Other - Last Name:GUELZOW
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:MS
Mailing Address - Street 1:501 PARK AVE
Mailing Address - Street 2:
Mailing Address - City:OCONTO
Mailing Address - State:WI
Mailing Address - Zip Code:54153-1612
Mailing Address - Country:US
Mailing Address - Phone:920-834-7000
Mailing Address - Fax:920-834-6889
Practice Address - Street 1:501 PARK AVE
Practice Address - Street 2:
Practice Address - City:OCONTO
Practice Address - State:WI
Practice Address - Zip Code:54153-1612
Practice Address - Country:US
Practice Address - Phone:920-834-7000
Practice Address - Fax:920-834-6889
Is Sole Proprietor?:No
Enumeration Date:2007-01-05
Last Update Date:2021-03-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
No101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)
No104100000XBehavioral Health & Social Service ProvidersSocial Worker
Provider Identifiers
StateIdentifier IDID TypeIssuer
WI32980400Medicaid
WI43427200Medicaid
WI32980400Medicaid