Healthcare Provider Details

I. General information

NPI: 1720913155
Provider Name (Legal Business Name): JULIE ENGELSDORFER LPMT, MT-BC
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 06/16/2026
Last Update Date: 06/16/2026
Certification Date: 06/16/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1100 BEECH ST BLDG 12-1
NORMAL IL
61761-1569
US

IV. Provider business mailing address

915 E WALNUT ST
BLOOMINGTON IL
61701-3358
US

V. Phone/Fax

Practice location:
  • Phone: 618-791-8143
  • Fax:
Mailing address:
  • Phone: 618-791-8143
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225A00000X
TaxonomyMusic Therapist
License Number144.000139
License Number StateIL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: