Provider Demographics
NPI:1295945988
Name:DAHLKE, JULIE T (MT-BC)
Entity type:Individual
Prefix:
First Name:JULIE
Middle Name:T
Last Name:DAHLKE
Suffix:
Gender:F
Credentials:MT-BC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:507 W NORTHRIDGE DR
Mailing Address - Street 2:
Mailing Address - City:MAHOMET
Mailing Address - State:IL
Mailing Address - Zip Code:61853-8909
Mailing Address - Country:US
Mailing Address - Phone:217-586-5050
Mailing Address - Fax:
Practice Address - Street 1:507 W NORTHRIDGE DR
Practice Address - Street 2:
Practice Address - City:MAHOMET
Practice Address - State:IL
Practice Address - Zip Code:61853-8909
Practice Address - Country:US
Practice Address - Phone:217-586-5050
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-05-23
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes174400000XOther Service ProvidersSpecialist