Provider Demographics
NPI:1144687039
Name:RAYMOND, JULIE (LCPC)
Entity type:Individual
Prefix:
First Name:JULIE
Middle Name:
Last Name:RAYMOND
Suffix:
Gender:F
Credentials:LCPC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1900 N LINCOLN AVE UNIT B01
Mailing Address - Street 2:
Mailing Address - City:CHICAGO
Mailing Address - State:IL
Mailing Address - Zip Code:60614-6573
Mailing Address - Country:US
Mailing Address - Phone:312-888-6935
Mailing Address - Fax:
Practice Address - Street 1:300 W ADAMS ST STE 514
Practice Address - Street 2:
Practice Address - City:CHICAGO
Practice Address - State:IL
Practice Address - Zip Code:60606-5108
Practice Address - Country:US
Practice Address - Phone:312-578-9990
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2016-01-22
Last Update Date:2016-01-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL180.010054172V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes172V00000XOther Service ProvidersCommunity Health Worker