Provider Demographics
NPI:1952840563
Name:SHEA, JULIE M (LCSW)
Entity Type:Individual
Prefix:
First Name:JULIE
Middle Name:M
Last Name:SHEA
Suffix:
Gender:F
Credentials:LCSW
Other - Prefix:
Other - First Name:JULIE
Other - Middle Name:
Other - Last Name:PRELL
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:APSW
Mailing Address - Street 1:1605 BLUEBIRD CT
Mailing Address - Street 2:
Mailing Address - City:NEENAH
Mailing Address - State:WI
Mailing Address - Zip Code:54956-1991
Mailing Address - Country:US
Mailing Address - Phone:208-553-0918
Mailing Address - Fax:920-364-2451
Practice Address - Street 1:1605 BLUEBIRD CT
Practice Address - Street 2:
Practice Address - City:NEENAH
Practice Address - State:WI
Practice Address - Zip Code:54956-1991
Practice Address - Country:US
Practice Address - Phone:208-553-0918
Practice Address - Fax:920-364-2451
Is Sole Proprietor?:Yes
Enumeration Date:2017-02-15
Last Update Date:2023-01-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI8368-1231041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
WI100065061Medicaid