Provider Demographics
NPI:1609885862
Name:KOGAN-WHITE, JULIE ANN (MA)
Entity Type:Individual
Prefix:MS
First Name:JULIE
Middle Name:ANN
Last Name:KOGAN-WHITE
Suffix:
Gender:F
Credentials:MA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:616 E 132ND ST
Mailing Address - Street 2:
Mailing Address - City:BURNSVILLE
Mailing Address - State:MN
Mailing Address - Zip Code:55337-3811
Mailing Address - Country:US
Mailing Address - Phone:651-649-2625
Mailing Address - Fax:651-645-3534
Practice Address - Street 1:1600 UNIVERSITY AVE W STE 505
Practice Address - Street 2:
Practice Address - City:SAINT PAUL
Practice Address - State:MN
Practice Address - Zip Code:55104-3825
Practice Address - Country:US
Practice Address - Phone:651-649-2625
Practice Address - Fax:651-645-3534
Is Sole Proprietor?:No
Enumeration Date:2006-08-05
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MN061461041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical