Provider Demographics
NPI:1700811486
Name:CHILDS, JULIE ANN (MSW)
Entity Type:Individual
Prefix:MS
First Name:JULIE
Middle Name:ANN
Last Name:CHILDS
Suffix:
Gender:F
Credentials:MSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:14275 PALM ST NW
Mailing Address - Street 2:
Mailing Address - City:ANDOVER
Mailing Address - State:MN
Mailing Address - Zip Code:55304-4172
Mailing Address - Country:US
Mailing Address - Phone:763-862-6632
Mailing Address - Fax:
Practice Address - Street 1:2353 RICE ST
Practice Address - Street 2:SUITE 214
Practice Address - City:ROSEVILLE
Practice Address - State:MN
Practice Address - Zip Code:55113-3739
Practice Address - Country:US
Practice Address - Phone:651-783-5656
Practice Address - Fax:651-483-1525
Is Sole Proprietor?:No
Enumeration Date:2006-07-11
Last Update Date:2009-04-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MN301162101YA0400X
MN112721041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
No101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)
Provider Identifiers
StateIdentifier IDID TypeIssuer
MN163T1CHOtherBLUE CROSS BLUE SHIELD
MN444267900Medicaid
MN01031200OtherPREFERRED ONE