Provider Demographics
NPI:1497936272
Name:WILKE, JULIE D (MSW, ACSW, LCSW)
Entity Type:Individual
Prefix:MS
First Name:JULIE
Middle Name:D
Last Name:WILKE
Suffix:
Gender:F
Credentials:MSW, ACSW, LCSW
Other - Prefix:MS
Other - First Name:JULIE
Other - Middle Name:WILKE
Other - Last Name:PANGRAC
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:MSW, ACSW, LCSW
Mailing Address - Street 1:2334 STERLING AVE
Mailing Address - Street 2:
Mailing Address - City:ELKHART
Mailing Address - State:IN
Mailing Address - Zip Code:46516-4969
Mailing Address - Country:US
Mailing Address - Phone:574-522-9246
Mailing Address - Fax:574-522-5806
Practice Address - Street 1:2334 STERLING AVE
Practice Address - Street 2:
Practice Address - City:ELKHART
Practice Address - State:IN
Practice Address - Zip Code:46516-4969
Practice Address - Country:US
Practice Address - Phone:574-522-9246
Practice Address - Fax:574-522-5806
Is Sole Proprietor?:Yes
Enumeration Date:2007-11-20
Last Update Date:2007-11-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN34002067A1041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical