Provider Demographics
NPI:1245293109
Name:DOTSON, JULIE ANN (MA)
Entity type:Individual
Prefix:MRS
First Name:JULIE
Middle Name:ANN
Last Name:DOTSON
Suffix:
Gender:F
Credentials:MA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:303 WEST RICHTON ROAD
Mailing Address - Street 2:
Mailing Address - City:STEGER
Mailing Address - State:IL
Mailing Address - Zip Code:60475
Mailing Address - Country:US
Mailing Address - Phone:708-709-0105
Mailing Address - Fax:
Practice Address - Street 1:110 MOONEY DRIVE
Practice Address - Street 2:SUITE 1
Practice Address - City:BOURBONNAIS
Practice Address - State:IL
Practice Address - Zip Code:60914
Practice Address - Country:US
Practice Address - Phone:815-933-7887
Practice Address - Fax:815-933-7870
Is Sole Proprietor?:Not Answered
Enumeration Date:2006-04-10
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL101Y00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101Y00000XBehavioral Health & Social Service ProvidersCounselor