Provider Demographics
NPI:1508031329
Name:KONRARDY-CROMEY, JULIA K (BA, CSAC, ICS)
Entity Type:Individual
Prefix:
First Name:JULIA
Middle Name:K
Last Name:KONRARDY-CROMEY
Suffix:
Gender:F
Credentials:BA, CSAC, ICS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:230 W WELLS ST
Mailing Address - Street 2:SUITE 312
Mailing Address - City:MILWAUKEE
Mailing Address - State:WI
Mailing Address - Zip Code:53203-1866
Mailing Address - Country:US
Mailing Address - Phone:414-344-3406
Mailing Address - Fax:414-344-0107
Practice Address - Street 1:230 W WELLS ST
Practice Address - Street 2:SUITE 312
Practice Address - City:MILWAUKEE
Practice Address - State:WI
Practice Address - Zip Code:53203-1866
Practice Address - Country:US
Practice Address - Phone:414-344-3406
Practice Address - Fax:414-344-0107
Is Sole Proprietor?:No
Enumeration Date:2008-04-23
Last Update Date:2008-04-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI14166-132101YA0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)
Provider Identifiers
StateIdentifier IDID TypeIssuer
WI39174900Medicaid