Provider Demographics
NPI:1861566267
Name:DEISINGER, JULIE A (PHD)
Entity type:Individual
Prefix:DR
First Name:JULIE
Middle Name:A
Last Name:DEISINGER
Suffix:
Gender:F
Credentials:PHD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:60 ORLAND SQUARE DR
Mailing Address - Street 2:SUITE 203
Mailing Address - City:ORLAND PARK
Mailing Address - State:IL
Mailing Address - Zip Code:60462-6548
Mailing Address - Country:US
Mailing Address - Phone:708-364-7046
Mailing Address - Fax:708-364-7048
Practice Address - Street 1:60 ORLAND SQUARE DR
Practice Address - Street 2:SUITE 203
Practice Address - City:ORLAND PARK
Practice Address - State:IL
Practice Address - Zip Code:60462-6548
Practice Address - Country:US
Practice Address - Phone:708-364-7046
Practice Address - Fax:708-364-7048
Is Sole Proprietor?:No
Enumeration Date:2006-11-17
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL103T00000X, 103TC0700X, 103TC2200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Not Answered103T00000XBehavioral Health & Social Service ProvidersPsychologist
Not Answered103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical
Not Answered103TC2200XBehavioral Health & Social Service ProvidersPsychologistClinical Child & Adolescent
Provider Identifiers
StateIdentifier IDID TypeIssuer
ILK04992Medicare ID - Type Unspecified