Provider Demographics
NPI:1982858452
Name:ROEDL, JULIE ANN (MS, LCPC)
Entity Type:Individual
Prefix:MRS
First Name:JULIE
Middle Name:ANN
Last Name:ROEDL
Suffix:
Gender:F
Credentials:MS, LCPC
Other - Prefix:MS
Other - First Name:JULIE
Other - Middle Name:ANN
Other - Last Name:TULL
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:MS, LCPC
Mailing Address - Street 1:10521 E AMINOFF DR
Mailing Address - Street 2:
Mailing Address - City:EFFINGHAM
Mailing Address - State:IL
Mailing Address - Zip Code:62401-4496
Mailing Address - Country:US
Mailing Address - Phone:217-821-2876
Mailing Address - Fax:
Practice Address - Street 1:10521 E AMINOFF DR
Practice Address - Street 2:
Practice Address - City:EFFINGHAM
Practice Address - State:IL
Practice Address - Zip Code:62401-4496
Practice Address - Country:US
Practice Address - Phone:217-821-2876
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2008-11-11
Last Update Date:2008-11-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL180-002066101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional