=====================================================
General NPI Number Information
=====================================================
NPI Number | 1366314866
-----------------------------------------------------
Entity Type | Individual
-----------------------------------------------------
Provider Name | JULIE A PETERS MSW, LSW
-----------------------------------------------------
Gender | Female
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 09/23/2025
-----------------------------------------------------
Last Update Date | 09/23/2025
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 460 BRIARGATE DR STE 700
-----------------------------------------------------
City | SOUTH ELGIN
-----------------------------------------------------
State | IL
-----------------------------------------------------
Zip | 60177-2284
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 847-488-1999
-----------------------------------------------------
Fax | 847-488-9797
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 460 BRIARGATE DR STE 700
-----------------------------------------------------
City | SOUTH ELGIN
-----------------------------------------------------
State | IL
-----------------------------------------------------
Zip | 60177-2284
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 847-488-1999
-----------------------------------------------------
Fax | 847-488-9797
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position |
-----------------------------------------------------
Name |
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone |
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 314000000X
-----------------------------------------------------
Taxonomy Name | Skilled Nursing Facility
-----------------------------------------------------
License Number | 044011281
-----------------------------------------------------
License Number State | IL
-----------------------------------------------------
Taxonomy #2
-----------------------------------------------------
Taxonomy Code | 104100000X
-----------------------------------------------------
Taxonomy Name | Social Worker
-----------------------------------------------------
License Number | 150.1044.48
-----------------------------------------------------
License Number State | IL
-----------------------------------------------------