MEDICARE: JULIE A BATES LISW

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	1041C0700X	Clinical Social Worker	I10229	OH

General Provider Information

NPI Number	:	1831163161
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	JULIE A BATES LISW

Provider Business Mailing Address
First Line	:	453 ALLENBY DR
Second Line	:
City	:	MARYSVILLE
State	:	OH
Zip	:	43040-8722
Country	:	US
Telephone Number	:	937-642-0048
Fax Number	:	937-642-0048

Provider Business Practice Location Address
First Line	:	453 ALLENBY DR
Second Line	:
City	:	MARYSVILLE
State	:	OH
Zip	:	43040-8722
Country	:	US
Telephone Number	:	937-642-0048
Fax Number	:	937-642-0048

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	02/14/2006
Last Update Date	:	08/07/2007

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