Provider Demographics
NPI:1225392111
Name:BIRDSONG, JULIE ANN (LSW)
Entity Type:Individual
Prefix:MRS
First Name:JULIE
Middle Name:ANN
Last Name:BIRDSONG
Suffix:
Gender:F
Credentials:LSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2555 S DIXIE DR
Mailing Address - Street 2:100
Mailing Address - City:KETTERING
Mailing Address - State:OH
Mailing Address - Zip Code:45409-1539
Mailing Address - Country:US
Mailing Address - Phone:937-299-9060
Mailing Address - Fax:937-299-3040
Practice Address - Street 1:2555 S DIXIE DR
Practice Address - Street 2:100
Practice Address - City:KETTERING
Practice Address - State:OH
Practice Address - Zip Code:45409-1539
Practice Address - Country:US
Practice Address - Phone:937-299-9060
Practice Address - Fax:937-299-3040
Is Sole Proprietor?:No
Enumeration Date:2012-06-26
Last Update Date:2012-06-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OHS. 00044661041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical