Provider Demographics
NPI:1477726727
Name:DOROTHY, JULIANN FINNEGAN (MSW)
Entity Type:Individual
Prefix:
First Name:JULIANN
Middle Name:FINNEGAN
Last Name:DOROTHY
Suffix:
Gender:F
Credentials:MSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2323 WINDISH DR
Mailing Address - Street 2:
Mailing Address - City:GALESBURG
Mailing Address - State:IL
Mailing Address - Zip Code:61401-9780
Mailing Address - Country:US
Mailing Address - Phone:309-344-4326
Mailing Address - Fax:309-344-4368
Practice Address - Street 1:208 BANK ST
Practice Address - Street 2:
Practice Address - City:KEOKUK
Practice Address - State:IA
Practice Address - Zip Code:52632-5819
Practice Address - Country:US
Practice Address - Phone:319-524-3873
Practice Address - Fax:319-524-3876
Is Sole Proprietor?:No
Enumeration Date:2008-04-08
Last Update Date:2011-01-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IA01852104100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes104100000XBehavioral Health & Social Service ProvidersSocial Worker
Provider Identifiers
StateIdentifier IDID TypeIssuer
IL370984175OtherBRIDGEWAY FEIN