MEDICARE: JULIE M VONDERHOFF SR. LCSW

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	1041C0700X	Clinical Social Worker	2158-123	WI

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1164462743
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	JULIE M VONDERHOFF SR. LCSW

Provider Business Mailing Address
First Line	:	40 MAPLE ST
Second Line	:	PO BOX 470
City	:	WOODRUFF
State	:	WI
Zip	:	54568-0470
Country	:	US
Telephone Number	:	715-356-8000
Fax Number	:

Provider Business Practice Location Address
First Line	:	311 ELM ST
Second Line	:
City	:	WOODRUFF
State	:	WI
Zip	:	54568-9149
Country	:	US
Telephone Number	:	715-356-8540
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	06/08/2006
Last Update Date	:	07/09/2007

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