Provider Demographics
NPI:1164109757
Name:PEDI, JULIANNE (LCSW)
Entity Type:Individual
Prefix:
First Name:JULIANNE
Middle Name:
Last Name:PEDI
Suffix:
Gender:F
Credentials:LCSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5616 9TH AVE
Mailing Address - Street 2:
Mailing Address - City:COUNTRYSIDE
Mailing Address - State:IL
Mailing Address - Zip Code:60525-7293
Mailing Address - Country:US
Mailing Address - Phone:708-305-1323
Mailing Address - Fax:
Practice Address - Street 1:908 N ELM ST STE 207
Practice Address - Street 2:
Practice Address - City:HINSDALE
Practice Address - State:IL
Practice Address - Zip Code:60521-3637
Practice Address - Country:US
Practice Address - Phone:630-850-2120
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2023-07-05
Last Update Date:2023-07-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL149.0195811041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical