Provider Demographics
NPI:1952467599
Name:O'REILLY, JULIA
Entity Type:Individual
Prefix:MS
First Name:JULIA
Middle Name:
Last Name:O'REILLY
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6767 FRANK LLOYD WRIGHT AVE APT 119
Mailing Address - Street 2:
Mailing Address - City:MIDDLETON
Mailing Address - State:WI
Mailing Address - Zip Code:53562-1793
Mailing Address - Country:US
Mailing Address - Phone:608-669-3483
Mailing Address - Fax:
Practice Address - Street 1:6767 FRANK LLOYD WRIGHT AVE APT 119
Practice Address - Street 2:
Practice Address - City:MIDDLETON
Practice Address - State:WI
Practice Address - Zip Code:53562-1793
Practice Address - Country:US
Practice Address - Phone:608-669-3483
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-12-28
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI3102-123101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health