Provider Demographics
NPI:1841059466
Name:WEDEMEYER, M.A., LPC, JULIA MARIE (LPC)
Entity type:Individual
Prefix:MS
First Name:JULIA
Middle Name:MARIE
Last Name:WEDEMEYER, M.A., LPC
Suffix:
Gender:F
Credentials:LPC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:7617 THUNDERBIRD LN
Mailing Address - Street 2:
Mailing Address - City:COLORADO SPRINGS
Mailing Address - State:CO
Mailing Address - Zip Code:80919-2649
Mailing Address - Country:US
Mailing Address - Phone:719-205-0359
Mailing Address - Fax:
Practice Address - Street 1:7617 THUNDERBIRD LN
Practice Address - Street 2:
Practice Address - City:COLORADO SPRINGS
Practice Address - State:CO
Practice Address - Zip Code:80919-2649
Practice Address - Country:US
Practice Address - Phone:719-205-0359
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2024-03-18
Last Update Date:2024-03-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OHC.0008475101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional