Provider Demographics
NPI:1497239776
Name:HETHERINGTON, JULIE (LCSW)
Entity type:Individual
Prefix:
First Name:JULIE
Middle Name:
Last Name:HETHERINGTON
Suffix:
Gender:F
Credentials:LCSW
Other - Prefix:
Other - First Name:JULIE
Other - Middle Name:
Other - Last Name:KANTOR
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:PO BOX 856
Mailing Address - Street 2:
Mailing Address - City:ANTIOCH
Mailing Address - State:IL
Mailing Address - Zip Code:60002-0856
Mailing Address - Country:US
Mailing Address - Phone:847-903-5604
Mailing Address - Fax:224-788-5112
Practice Address - Street 1:5083 SWITCH GRASS LN
Practice Address - Street 2:
Practice Address - City:NAPERVILLE
Practice Address - State:IL
Practice Address - Zip Code:60564-5368
Practice Address - Country:US
Practice Address - Phone:630-362-3045
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2018-09-21
Last Update Date:2018-10-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL1490137721041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical