Healthcare Provider Details

I. General information

NPI: 1467122895
Provider Name (Legal Business Name): JULIE C RECORDS LICSW
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: JULIE A COONEY

II. Dates (important events)

Enumeration Date: 09/16/2021
Last Update Date: 09/16/2021
Certification Date: 09/16/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1200 MARQUETTE AVE
MINNEAPOLIS MN
55403-2419
US

IV. Provider business mailing address

3395 PLYMOUTH RD
MINNETONKA MN
55305-3633
US

V. Phone/Fax

Practice location:
  • Phone: 612-790-9029
  • Fax: 612-503-1980
Mailing address:
  • Phone: 952-548-8657
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License Number25565
License Number StateMN

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: