Provider Demographics
NPI:1306186127
Name:LEWIS, JULIE SIGNE (SACIT)
Entity Type:Individual
Prefix:
First Name:JULIE
Middle Name:SIGNE
Last Name:LEWIS
Suffix:
Gender:F
Credentials:SACIT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:210 S JACKSON ST
Mailing Address - Street 2:
Mailing Address - City:JANESVILLE
Mailing Address - State:WI
Mailing Address - Zip Code:53548-4717
Mailing Address - Country:US
Mailing Address - Phone:608-754-6800
Mailing Address - Fax:608-754-2651
Practice Address - Street 1:314 W COURT ST
Practice Address - Street 2:
Practice Address - City:JANESVILLE
Practice Address - State:WI
Practice Address - Zip Code:53548-3846
Practice Address - Country:US
Practice Address - Phone:608-373-9650
Practice Address - Fax:608-754-2651
Is Sole Proprietor?:No
Enumeration Date:2013-02-15
Last Update Date:2024-04-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI16662-130101YA0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)