Provider Demographics
NPI:1598826471
Name:SIGLER EDMUNDSON, JULIE (MS,LPC,CSAC,ICS)
Entity Type:Individual
Prefix:
First Name:JULIE
Middle Name:
Last Name:SIGLER EDMUNDSON
Suffix:
Gender:F
Credentials:MS,LPC,CSAC,ICS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5820 PAUL REVERE CT
Mailing Address - Street 2:
Mailing Address - City:WISCONSIN RAPIDS
Mailing Address - State:WI
Mailing Address - Zip Code:54494-3490
Mailing Address - Country:US
Mailing Address - Phone:715-213-3503
Mailing Address - Fax:
Practice Address - Street 1:1100 LAKE VIEW DR
Practice Address - Street 2:PREMIER RECOVERY
Practice Address - City:WAUSAU
Practice Address - State:WI
Practice Address - Zip Code:54403-6785
Practice Address - Country:US
Practice Address - Phone:715-213-3503
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-12-13
Last Update Date:2010-09-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI10668101YA0400X
WI4416-125101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)
No101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional
Provider Identifiers
StateIdentifier IDID TypeIssuer
WI39381100Medicaid