Provider Demographics
NPI:1912087784
Name:WITT, JULIA T (BA)
Entity Type:Individual
Prefix:
First Name:JULIA
Middle Name:T
Last Name:WITT
Suffix:
Gender:F
Credentials:BA
Other - Prefix:
Other - First Name:JULIA
Other - Middle Name:T
Other - Last Name:KERR
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:BA
Mailing Address - Street 1:501 PARK AVE
Mailing Address - Street 2:
Mailing Address - City:OCONTO
Mailing Address - State:WI
Mailing Address - Zip Code:54153-1612
Mailing Address - Country:US
Mailing Address - Phone:920-834-7000
Mailing Address - Fax:920-834-6889
Practice Address - Street 1:501 PARK AVE
Practice Address - Street 2:
Practice Address - City:OCONTO
Practice Address - State:WI
Practice Address - Zip Code:54153-1612
Practice Address - Country:US
Practice Address - Phone:920-834-7000
Practice Address - Fax:920-834-6889
Is Sole Proprietor?:No
Enumeration Date:2006-10-16
Last Update Date:2011-08-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI11048101Y00000X
WI11048-132101YA0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)
No101Y00000XBehavioral Health & Social Service ProvidersCounselor
Provider Identifiers
StateIdentifier IDID TypeIssuer
WI39387500Medicaid
11953294OtherCAQH