Provider Demographics
NPI:1952030629
Name:SIMMONS, JULIE LYNN (:CSW)
Entity Type:Individual
Prefix:
First Name:JULIE
Middle Name:LYNN
Last Name:SIMMONS
Suffix:
Gender:F
Credentials::CSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:52021 CLOVERLEAF DR W
Mailing Address - Street 2:
Mailing Address - City:SOUTH BEND
Mailing Address - State:IN
Mailing Address - Zip Code:46637-6034
Mailing Address - Country:US
Mailing Address - Phone:574-231-6766
Mailing Address - Fax:833-249-2411
Practice Address - Street 1:6910 N MAIN ST UNIT 52
Practice Address - Street 2:
Practice Address - City:GRANGER
Practice Address - State:IN
Practice Address - Zip Code:46530-8412
Practice Address - Country:US
Practice Address - Phone:574-231-6766
Practice Address - Fax:833-249-2411
Is Sole Proprietor?:No
Enumeration Date:2022-06-08
Last Update Date:2022-06-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN34009741A1041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
OTHEROtherOTHER