Provider Demographics
NPI:1629303748
Name:WIEGEL, JULIE (PYSD)
Entity Type:Individual
Prefix:
First Name:JULIE
Middle Name:
Last Name:WIEGEL
Suffix:
Gender:F
Credentials:PYSD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3350 SALT CREEK LANE
Mailing Address - Street 2:SUITE 114
Mailing Address - City:ARLINGTON
Mailing Address - State:IL
Mailing Address - Zip Code:60005-1089
Mailing Address - Country:US
Mailing Address - Phone:847-952-7460
Mailing Address - Fax:
Practice Address - Street 1:3350 SALT CREEK LANE
Practice Address - Street 2:SUITE 114
Practice Address - City:ARLINGTON
Practice Address - State:IL
Practice Address - Zip Code:60005-1089
Practice Address - Country:US
Practice Address - Phone:847-952-7460
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2009-10-07
Last Update Date:2009-10-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL071007686103T00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103T00000XBehavioral Health & Social Service ProvidersPsychologist