Provider Demographics
NPI:1689015992
Name:PETERSON, JULIE A (PSYD)
Entity type:Individual
Prefix:DR
First Name:JULIE
Middle Name:A
Last Name:PETERSON
Suffix:
Gender:F
Credentials:PSYD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:15 SPINNING WHEEL RD STE 426
Mailing Address - Street 2:
Mailing Address - City:HINSDALE
Mailing Address - State:IL
Mailing Address - Zip Code:60521-7671
Mailing Address - Country:US
Mailing Address - Phone:630-634-8526
Mailing Address - Fax:630-323-3058
Practice Address - Street 1:15 SPINNING WHEEL RD STE 426
Practice Address - Street 2:
Practice Address - City:HINSDALE
Practice Address - State:IL
Practice Address - Zip Code:60521-7671
Practice Address - Country:US
Practice Address - Phone:630-634-8526
Practice Address - Fax:630-323-3058
Is Sole Proprietor?:No
Enumeration Date:2013-07-15
Last Update Date:2021-06-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
106H00000X
IL071009559103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical
No106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist