Healthcare Provider Details

I. General information

NPI: 1083758379
Provider Name (Legal Business Name): JULIE M REILLY L.I.S.W.
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 02/19/2007
Last Update Date: 07/09/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1523 S BLUFF BLVD
CLINTON IA
52732-6549
US

IV. Provider business mailing address

1523 S BLUFF BLVD
CLINTON IA
52732-6549
US

V. Phone/Fax

Practice location:
  • Phone: 563-243-6054
  • Fax: 563-243-6828
Mailing address:
  • Phone: 563-243-6054
  • Fax: 563-243-6828

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code104100000X
TaxonomySocial Worker
License Number00652
License Number StateIA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: