Provider Demographics
NPI:1487476834
Name:JULIE SODERBERG, LICSW
Entity type:Organization
Organization Name:JULIE SODERBERG, LICSW
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER/OPERATOR
Authorized Official - Prefix:
Authorized Official - First Name:JULIE
Authorized Official - Middle Name:ANN
Authorized Official - Last Name:SODERBERG
Authorized Official - Suffix:
Authorized Official - Credentials:LICSW
Authorized Official - Phone:218-591-4715
Mailing Address - Street 1:5909 N SHORE DR
Mailing Address - Street 2:
Mailing Address - City:DULUTH
Mailing Address - State:MN
Mailing Address - Zip Code:55804-9655
Mailing Address - Country:US
Mailing Address - Phone:218-591-4715
Mailing Address - Fax:
Practice Address - Street 1:5909 N SHORE DR
Practice Address - Street 2:
Practice Address - City:DULUTH
Practice Address - State:MN
Practice Address - Zip Code:55804-9655
Practice Address - Country:US
Practice Address - Phone:218-591-4715
Practice Address - Fax:218-669-0093
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2024-10-28
Last Update Date:2024-12-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinicalGroup - Single Specialty