Provider Demographics
NPI:1982659538
Name:BOBHOLZ, JULIE A (PHD)
Entity Type:Individual
Prefix:MS
First Name:JULIE
Middle Name:A
Last Name:BOBHOLZ
Suffix:
Gender:F
Credentials:PHD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1035 KEPLER DR
Mailing Address - Street 2:
Mailing Address - City:GREEN BAY
Mailing Address - State:WI
Mailing Address - Zip Code:54311-8320
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:920-288-8329
Practice Address - Street 1:2845 GREENBRIER RD
Practice Address - Street 2:STE. 340
Practice Address - City:GREEN BAY
Practice Address - State:WI
Practice Address - Zip Code:54311-6519
Practice Address - Country:US
Practice Address - Phone:920-288-8030
Practice Address - Fax:920-288-8329
Is Sole Proprietor?:No
Enumeration Date:2006-05-23
Last Update Date:2024-04-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI2241103G00000X, 103G00000X, 103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical
Yes103G00000XBehavioral Health & Social Service ProvidersClinical Neuropsychologist
Provider Identifiers
StateIdentifier IDID TypeIssuer
WI1982659538Medicaid
008000315OOtherHUMANA
008000315OOtherHUMANA
P06510Medicare UPIN