Provider Demographics
NPI:1851411383
Name:HAUGEN, JULIE ANN (COTAL)
Entity Type:Individual
Prefix:MRS
First Name:JULIE
Middle Name:ANN
Last Name:HAUGEN
Suffix:
Gender:F
Credentials:COTAL
Other - Prefix:
Other - First Name:JULIE
Other - Middle Name:ANN
Other - Last Name:YOUNG
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:COTAL
Mailing Address - Street 1:519 N MARSHFIELD AVE
Mailing Address - Street 2:
Mailing Address - City:CHICAGO
Mailing Address - State:IL
Mailing Address - Zip Code:60622-6315
Mailing Address - Country:US
Mailing Address - Phone:312-226-2364
Mailing Address - Fax:
Practice Address - Street 1:222 S RIVERSIDE PLZ
Practice Address - Street 2:SUITE 830
Practice Address - City:CHICAGO
Practice Address - State:IL
Practice Address - Zip Code:60606-5808
Practice Address - Country:US
Practice Address - Phone:866-386-0773
Practice Address - Fax:312-627-2700
Is Sole Proprietor?:Yes
Enumeration Date:2007-03-29
Last Update Date:2014-01-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL057.001708224Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes224Z00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapy Assistant