Provider Demographics
NPI:1184409666
Name:SODERBERG, JULIE A (LICSW)
Entity type:Individual
Prefix:
First Name:JULIE
Middle Name:A
Last Name:SODERBERG
Suffix:
Gender:F
Credentials:LICSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5909 N SHORE DR
Mailing Address - Street 2:
Mailing Address - City:DULUTH
Mailing Address - State:MN
Mailing Address - Zip Code:55804-9655
Mailing Address - Country:US
Mailing Address - Phone:218-591-4715
Mailing Address - Fax:
Practice Address - Street 1:5909 N SHORE DR
Practice Address - Street 2:
Practice Address - City:DULUTH
Practice Address - State:MN
Practice Address - Zip Code:55804-9655
Practice Address - Country:US
Practice Address - Phone:218-591-4715
Practice Address - Fax:218-669-0093
Is Sole Proprietor?:Yes
Enumeration Date:2023-08-31
Last Update Date:2024-10-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MN261591041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical