1730261694 NPI number — MRS. JULIE ANN HESTER MSW

Table of content: MRS. JULIE ANN HESTER MSW (NPI 1730261694)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1730261694 NPI number — MRS. JULIE ANN HESTER MSW

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
HESTER
Provider First Name:
JULIE
Provider Middle Name:
ANN
Provider Name Prefix Text:
MRS.
Provider Name Suffix Text:
Provider Credential Text:
MSW
Provider Gender Code:
F

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
MERTEN
Provider Other First Name:
JULIE
Provider Other Middle Name:
ANN
Provider Other Name Prefix Text:
MISS
Provider Other Name Suffix Text:
Provider Other Credential Text:
MSW
Provider Other Last Name Type Code:
1

NPI Number Information

NPI Number:
1730261694
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
08/23/2023
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
1027 N SHAKERVILLE RD
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
OCONOMOWOC
Provider Business Mailing Address State Name:
WI
Provider Business Mailing Address Postal Code:
53066-8792
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
262-646-5378
Provider Business Mailing Address Fax Number:
262-646-5383

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
888 THACKERAY TRL STE 211
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
OCONOMOWOC
Provider Business Practice Location Address State Name:
WI
Provider Business Practice Location Address Postal Code:
53066-4342
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
414-659-6635
Provider Business Practice Location Address Fax Number:
262-567-1481
Provider Enumeration Date:
10/19/2006

Additional Information

Authorized Official

Authorized Official Last Name:
Authorized Official First Name:
Authorized Official Middle Name:
Authorized Official Title or Position:
Authorized Official Telephone Number:

Provider Taxonomy Codes

  • Taxonomy code: 1041C0700X , with the licence number:  675121 , registered in the state of WI ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)

  • Identifier: 39773500 , issued by the state of ( WI ) . This identifiers is of the category "MEDICAID".




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