Provider Demographics
NPI:1194382614
Name:WAREHAM, JULIE
Entity Type:Individual
Prefix:
First Name:JULIE
Middle Name:
Last Name:WAREHAM
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 1:2708 WILLOW RIDGE DR
Mailing Address - Street 2:
Mailing Address - City:NAPERVILLE
Mailing Address - State:IL
Mailing Address - Zip Code:60564-8950
Mailing Address - Country:US
Mailing Address - Phone:630-696-2621
Mailing Address - Fax:
Practice Address - Street 1:603 E DIEHL RD STE 123
Practice Address - Street 2:
Practice Address - City:NAPERVILLE
Practice Address - State:IL
Practice Address - Zip Code:60563-4908
Practice Address - Country:US
Practice Address - Phone:331-826-0226
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2019-05-20
Last Update Date:2019-05-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ILW65042394812103K00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103K00000XBehavioral Health & Social Service ProvidersBehavior Analyst