Provider Demographics
NPI:1952840563
Name:SHEA, JULIE M (LCSW)
Entity type:Individual
Prefix:
First Name:JULIE
Middle Name:M
Last Name:SHEA
Suffix:
Gender:
Credentials:LCSW
Other - Prefix:
Other - First Name:JULIE
Other - Middle Name:
Other - Last Name:PRELL
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:APSW
Mailing Address - Street 1:W7933 VERMEER ST
Mailing Address - Street 2:
Mailing Address - City:HOLMEN
Mailing Address - State:WI
Mailing Address - Zip Code:54636-4201
Mailing Address - Country:US
Mailing Address - Phone:608-218-4245
Mailing Address - Fax:920-383-3299
Practice Address - Street 1:704 SAND LAKE RD STE 207E
Practice Address - Street 2:
Practice Address - City:ONALASKA
Practice Address - State:WI
Practice Address - Zip Code:54650-2400
Practice Address - Country:US
Practice Address - Phone:608-218-4245
Practice Address - Fax:920-383-3299
Is Sole Proprietor?:Yes
Enumeration Date:2017-02-15
Last Update Date:2025-04-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI8368-1231041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
WI100065061Medicaid