MEDICARE: JULIE ANN GATLIN LISW-S

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	I9909-S	OH

General Provider Information

NPI Number	:	1255783890
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	JULIE ANN GATLIN LISW-S

Provider Business Mailing Address
First Line	:	10383 KINGSPORT DR
Second Line	:
City	:	CINCINNATI
State	:	OH
Zip	:	45241-3144
Country	:	US
Telephone Number	:	513-289-8667
Fax Number	:

Provider Business Practice Location Address
First Line	:	7162 READING RD STE 300
Second Line	:
City	:	CINCINNATI
State	:	OH
Zip	:	45237-3899
Country	:	US
Telephone Number	:	513-961-5900
Fax Number	:	513-961-5903

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

Provider Enumeration Date	:	07/07/2016
Last Update Date	:	07/07/2016

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