Provider Demographics
NPI:1952423998
Name:THOMPSON, JULIE NONA (LCSW)
Entity Type:Individual
Prefix:MS
First Name:JULIE
Middle Name:NONA
Last Name:THOMPSON
Suffix:
Gender:F
Credentials:LCSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:401 S JACKSON RD
Mailing Address - Street 2:
Mailing Address - City:PECATONICA
Mailing Address - State:IL
Mailing Address - Zip Code:61063-9337
Mailing Address - Country:US
Mailing Address - Phone:815-742-0315
Mailing Address - Fax:815-247-9063
Practice Address - Street 1:773 W LINCOLN ST
Practice Address - Street 2:
Practice Address - City:FREEPORT
Practice Address - State:IL
Practice Address - Zip Code:61032-4976
Practice Address - Country:US
Practice Address - Phone:815-742-0315
Practice Address - Fax:815-247-9063
Is Sole Proprietor?:Yes
Enumeration Date:2007-04-03
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL1041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
IL0008932023OtherBCBSIL