Provider Demographics
NPI:1023657285
Name:BOLTE, JULIA MARIE
Entity type:Individual
Prefix:
First Name:JULIA
Middle Name:MARIE
Last Name:BOLTE
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3629 152ND LN NW
Mailing Address - Street 2:
Mailing Address - City:ANDOVER
Mailing Address - State:MN
Mailing Address - Zip Code:55304-3008
Mailing Address - Country:US
Mailing Address - Phone:612-804-2785
Mailing Address - Fax:
Practice Address - Street 1:3629 152ND LN NW
Practice Address - Street 2:
Practice Address - City:ANDOVER
Practice Address - State:MN
Practice Address - Zip Code:55304-3008
Practice Address - Country:US
Practice Address - Phone:612-804-2785
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2020-01-04
Last Update Date:2020-01-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MN1102691253J00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes253J00000XAgenciesFoster Care Agency