Provider Demographics
NPI:1255505202
Name:SMILEY, JULIE C (MA)
Entity type:Individual
Prefix:MRS
First Name:JULIE
Middle Name:C
Last Name:SMILEY
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 1:630 KENDALLWOOD CT
Mailing Address - Street 2:
Mailing Address - City:CRYSTAL LAKE
Mailing Address - State:IL
Mailing Address - Zip Code:60014-8450
Mailing Address - Country:US
Mailing Address - Phone:815-356-1998
Mailing Address - Fax:815-356-6993
Practice Address - Street 1:630 KENDALLWOOD CT
Practice Address - Street 2:
Practice Address - City:CRYSTAL LAKE
Practice Address - State:IL
Practice Address - Zip Code:60014-8450
Practice Address - Country:US
Practice Address - Phone:815-356-1998
Practice Address - Fax:815-356-6993
Is Sole Proprietor?:Yes
Enumeration Date:2008-04-21
Last Update Date:2008-04-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes222Q00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersDevelopmental Therapist