Provider Demographics
NPI:1477215655
Name:BIETSCH, JULIA KRISTINA ANN
Entity Type:Individual
Prefix:
First Name:JULIA
Middle Name:KRISTINA ANN
Last Name:BIETSCH
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 1:4085 BLUESTONE DRIVE
Mailing Address - Street 2:#201
Mailing Address - City:ST. CHARLES
Mailing Address - State:MO
Mailing Address - Zip Code:63303
Mailing Address - Country:US
Mailing Address - Phone:573-330-0415
Mailing Address - Fax:
Practice Address - Street 1:4085 BLUESTONE DRIVE
Practice Address - Street 2:#201
Practice Address - City:ST. CHARLES
Practice Address - State:MO
Practice Address - Zip Code:63303
Practice Address - Country:US
Practice Address - Phone:573-330-0415
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2021-10-06
Last Update Date:2021-10-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional