Provider Demographics
NPI:1245611698
Name:GLYNN, JULIE
Entity Type:Individual
Prefix:
First Name:JULIE
Middle Name:
Last Name:GLYNN
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 1:10752 BEAL AVE
Mailing Address - Street 2:
Mailing Address - City:HAYWARD
Mailing Address - State:WI
Mailing Address - Zip Code:54843-6435
Mailing Address - Country:US
Mailing Address - Phone:715-634-0222
Mailing Address - Fax:715-634-1722
Practice Address - Street 1:10752 BEAL AVE
Practice Address - Street 2:
Practice Address - City:HAYWARD
Practice Address - State:WI
Practice Address - Zip Code:54843-6435
Practice Address - Country:US
Practice Address - Phone:715-634-0222
Practice Address - Fax:715-634-1722
Is Sole Proprietor?:No
Enumeration Date:2015-06-11
Last Update Date:2015-06-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI82621041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical