Provider Demographics
NPI:1053724971
Name:ROWE, JULIE
Entity type:Individual
Prefix:
First Name:JULIE
Middle Name:
Last Name:ROWE
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 1:741 WINKLER DR
Mailing Address - Street 2:
Mailing Address - City:WOOSTER
Mailing Address - State:OH
Mailing Address - Zip Code:44691-1652
Mailing Address - Country:US
Mailing Address - Phone:330-345-6771
Mailing Address - Fax:
Practice Address - Street 1:485 TOWNSHIP ROAD 1902
Practice Address - Street 2:
Practice Address - City:JEROMESVILLE
Practice Address - State:OH
Practice Address - Zip Code:44840-9754
Practice Address - Country:US
Practice Address - Phone:330-345-6771
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2014-06-09
Last Update Date:2014-12-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OHOH3083792171M00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171M00000XOther Service ProvidersCase Manager/Care Coordinator
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH1053724971Medicaid