Provider Demographics
NPI:1205914488
Name:BULAU, JULIANNE S (MSW LICSW)
Entity type:Individual
Prefix:MS
First Name:JULIANNE
Middle Name:S
Last Name:BULAU
Suffix:
Gender:F
Credentials:MSW LICSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1923 WILBY RD
Mailing Address - Street 2:
Mailing Address - City:ALBERT LEA
Mailing Address - State:MN
Mailing Address - Zip Code:56007
Mailing Address - Country:US
Mailing Address - Phone:507-377-5446
Mailing Address - Fax:507-377-5505
Practice Address - Street 1:203 W CLARK ST
Practice Address - Street 2:FREEBORN COUNTY MENTAL HEALTH CENTER
Practice Address - City:ALBERT LEA
Practice Address - State:MN
Practice Address - Zip Code:56007
Practice Address - Country:US
Practice Address - Phone:507-377-5400
Practice Address - Fax:507-377-5505
Is Sole Proprietor?:No
Enumeration Date:2006-11-02
Last Update Date:2011-01-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MN142671041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
117216600OtherMHOP OF MN
MN01020801OtherPREFERRED ONE
MN11721600Medicaid
MN66D10BUOtherBCBS OF MN
MN6274944OtherUBH MEDICA
MN123766OtherUCARE
MN800000973Medicare ID - Type Unspecified