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General NPI Number Information
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NPI Number | 1487476834
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Entity Type | Organization
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Legal Business Name | JULIE SODERBERG, LICSW
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Dates
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Enumeration Date | 10/28/2024
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Last Update Date | 12/18/2024
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Provider Practice Location Address
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Address Line | 5909 N SHORE DR
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City | DULUTH
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State | MN
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Zip | 55804-9655
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Country | US
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Telephone | 218-591-4715
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Fax | 218-669-0093
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Provider Business Mailing Address
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Address Line | 5909 N SHORE DR
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City | DULUTH
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State | MN
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Zip | 55804-9655
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Country | US
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Telephone | 218-591-4715
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Fax |
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Authorized Official
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Title or Position | OWNER/OPERATOR
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Name | JULIE ANN SODERBERG
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Credential | LICSW
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Telephone | 218-591-4715
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 1041C0700X
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Taxonomy Name | Clinical Social Worker
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License Number |
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License Number State |
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