Provider Demographics
NPI:1821095357
Name:HARDY, JULIE LENA (LCSW)
Entity Type:Individual
Prefix:MRS
First Name:JULIE
Middle Name:LENA
Last Name:HARDY
Suffix:
Gender:F
Credentials:LCSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3001 CLINTON RD
Mailing Address - Street 2:
Mailing Address - City:SEDALIA
Mailing Address - State:MO
Mailing Address - Zip Code:65301-7917
Mailing Address - Country:US
Mailing Address - Phone:660-829-1133
Mailing Address - Fax:660-829-1144
Practice Address - Street 1:3001 CLINTON RD
Practice Address - Street 2:
Practice Address - City:SEDALIA
Practice Address - State:MO
Practice Address - Zip Code:65301-7917
Practice Address - Country:US
Practice Address - Phone:660-829-1133
Practice Address - Fax:660-829-1144
Is Sole Proprietor?:Not Answered
Enumeration Date:2005-06-30
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MOSW000968104100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes104100000XBehavioral Health & Social Service ProvidersSocial Worker
Provider Identifiers
StateIdentifier IDID TypeIssuer
MO0004270AMedicare ID - Type Unspecified