Healthcare Provider Details

I. General information

NPI: 1346880549
Provider Name (Legal Business Name): JULIA DOMBROW LCPC
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 01/15/2020
Last Update Date: 06/17/2026
Certification Date: 06/17/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

506 RHONDA DR
LOCKPORT IL
60441-3346
US

IV. Provider business mailing address

506 RHONDA DR
LOCKPORT IL
60441-3346
US

V. Phone/Fax

Practice location:
  • Phone: 708-505-6747
  • Fax:
Mailing address:
  • Phone: 708-370-0077
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License Number180014116
License Number StateIL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: