MEDICARE: JULIE LEE DORR

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	106H00000X	Marriage & Family Therapist	166001191	IL

General Provider Information

NPI Number	:	1235628876
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	JULIE LEE DORR

Provider Business Mailing Address
First Line	:	1504 GLENCOE AVE
Second Line	:
City	:	HIGHLAND PARK
State	:	IL
Zip	:	60035-3681
Country	:	US
Telephone Number	:	847-772-0260
Fax Number	:

Provider Business Practice Location Address
First Line	:	3633 W LAKE AVE STE 404
Second Line	:
City	:	GLENVIEW
State	:	IL
Zip	:	60026-5801
Country	:	US
Telephone Number	:	224-800-1106
Fax Number	:

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

Provider Enumeration Date	:	05/09/2018
Last Update Date	:	05/09/2018

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