=====================================================
General NPI Number Information
=====================================================
NPI Number | 1609041375
-----------------------------------------------------
Entity Type | Individual
-----------------------------------------------------
Provider Name | JULIA A FRIEDRICH LCSW
-----------------------------------------------------
Gender | Female
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 04/24/2008
-----------------------------------------------------
Last Update Date | 01/09/2017
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 515 22ND AVE MONROE CLINIC
-----------------------------------------------------
City | MONROE
-----------------------------------------------------
State | WI
-----------------------------------------------------
Zip | 53566-1569
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 608-324-2321
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 515 22ND AVE MONROE CLINIC
-----------------------------------------------------
City | MONROE
-----------------------------------------------------
State | WI
-----------------------------------------------------
Zip | 53566-1569
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 608-324-2321
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position |
-----------------------------------------------------
Name |
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone |
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 104100000X
-----------------------------------------------------
Taxonomy Name | Social Worker
-----------------------------------------------------
License Number | 127144121
-----------------------------------------------------
License Number State | WI
-----------------------------------------------------
Taxonomy #2
-----------------------------------------------------
Taxonomy Code | 1041C0700X
-----------------------------------------------------
Taxonomy Name | Clinical Social Worker
-----------------------------------------------------
License Number | 7688-123
-----------------------------------------------------
License Number State | WI
-----------------------------------------------------