=====================================================
General NPI Number Information
=====================================================
NPI Number | 1720913155
-----------------------------------------------------
Entity Type | Individual
-----------------------------------------------------
Provider Name | JULIE ENGELSDORFER LPMT, MT-BC
-----------------------------------------------------
Gender | Female
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 06/16/2026
-----------------------------------------------------
Last Update Date | 06/16/2026
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 1100 BEECH ST BLDG 12-1
-----------------------------------------------------
City | NORMAL
-----------------------------------------------------
State | IL
-----------------------------------------------------
Zip | 61761-1569
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 618-791-8143
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 915 E WALNUT ST
-----------------------------------------------------
City | BLOOMINGTON
-----------------------------------------------------
State | IL
-----------------------------------------------------
Zip | 61701-3358
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 618-791-8143
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position |
-----------------------------------------------------
Name |
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone |
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 225A00000X
-----------------------------------------------------
Taxonomy Name | Music Therapist
-----------------------------------------------------
License Number | 144.000139
-----------------------------------------------------
License Number State | IL
-----------------------------------------------------