Provider Demographics
NPI:1184919953
Name:FALLON, JULIE (LCSW)
Entity type:Individual
Prefix:MS
First Name:JULIE
Middle Name:
Last Name:FALLON
Suffix:
Gender:F
Credentials:LCSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4839 WOLF RD
Mailing Address - Street 2:
Mailing Address - City:WESTERN SPRINGS
Mailing Address - State:IL
Mailing Address - Zip Code:60558-1736
Mailing Address - Country:US
Mailing Address - Phone:708-829-1869
Mailing Address - Fax:
Practice Address - Street 1:4839 WOLF RD
Practice Address - Street 2:
Practice Address - City:WESTERN SPRINGS
Practice Address - State:IL
Practice Address - Zip Code:60558-1736
Practice Address - Country:US
Practice Address - Phone:708-829-1869
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2011-06-09
Last Update Date:2019-02-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL149.0094241041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical