Provider Demographics
NPI:1336117571
Name:WEGER, JULIE A (PHD)
Entity Type:Individual
Prefix:
First Name:JULIE
Middle Name:A
Last Name:WEGER
Suffix:
Gender:F
Credentials:PHD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3302 41ST ST
Mailing Address - Street 2:
Mailing Address - City:MOLINE
Mailing Address - State:IL
Mailing Address - Zip Code:61265-7830
Mailing Address - Country:US
Mailing Address - Phone:309-764-3912
Mailing Address - Fax:309-736-1804
Practice Address - Street 1:3302 41ST ST
Practice Address - Street 2:
Practice Address - City:MOLINE
Practice Address - State:IL
Practice Address - Zip Code:61265-7830
Practice Address - Country:US
Practice Address - Phone:309-764-3912
Practice Address - Fax:309-736-1804
Is Sole Proprietor?:No
Enumeration Date:2006-03-14
Last Update Date:2014-04-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL/071-006393103T00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103T00000XBehavioral Health & Social Service ProvidersPsychologist