Healthcare Provider Details

I. General information

NPI: 1598189508
Provider Name (Legal Business Name): JULIE HERR & ASSOCIATES
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 02/11/2014
Last Update Date: 02/11/2014
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2032 W GRAND AVE
CHICAGO IL
60612-1502
US

IV. Provider business mailing address

2032 W GRAND AVE
CHICAGO IL
60612-1502
US

V. Phone/Fax

Practice location:
  • Phone: 312-388-8883
  • Fax:
Mailing address:
  • Phone: 312-388-8883
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code222Q00000X
TaxonomyDevelopmental Therapist
License NumberJH07000505P
License Number StateIL
# 2
Primary TaxonomyN
Taxonomy Code252Y00000X
TaxonomyEarly Intervention Provider Agency
License NumberJH07000505P
License Number StateIL
# 3
Primary TaxonomyN
Taxonomy Code261QM0855X
TaxonomyAdolescent and Children Mental Health Clinic/Center
License NumberJH07000505P
License Number StateIL

VIII. Authorized Official

Name: JULIE HERR
Title or Position: OWNER
Credential: MS
Phone: 312-388-8883