Provider Demographics
NPI:1669662284
Name:RIDDLE, JULIE ANN (LICSW)
Entity Type:Individual
Prefix:MRS
First Name:JULIE
Middle Name:ANN
Last Name:RIDDLE
Suffix:
Gender:F
Credentials:LICSW
Other - Prefix:MS
Other - First Name:JULIE
Other - Middle Name:ANN
Other - Last Name:ABERLE
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:LICSW
Mailing Address - Street 1:117 N WASHINGTON ST STE 3
Mailing Address - Street 2:
Mailing Address - City:GRAND FORKS
Mailing Address - State:ND
Mailing Address - Zip Code:58203-3450
Mailing Address - Country:US
Mailing Address - Phone:218-791-0401
Mailing Address - Fax:701-757-1500
Practice Address - Street 1:117 N WASHINGTON ST STE 3
Practice Address - Street 2:
Practice Address - City:GRAND FORKS
Practice Address - State:ND
Practice Address - Zip Code:58203-3450
Practice Address - Country:US
Practice Address - Phone:218-791-0401
Practice Address - Fax:701-757-1500
Is Sole Proprietor?:No
Enumeration Date:2007-07-30
Last Update Date:2019-10-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ND36181041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
ND712698Medicare UPIN