Basic Information
| Provider Information | |||||||||
| NPI: | 1881930725 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | HOOYER | ||||||||
| FirstName: | JULIE | ||||||||
| MiddleName: | LYNN | ||||||||
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| Credential: | LISW | ||||||||
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| Mailing Information | |||||||||
| Address1: | 404 JEFFERSON ST | ||||||||
| Address2: | |||||||||
| City: | PELLA | ||||||||
| State: | IA | ||||||||
| PostalCode: | 502191257 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 6416283150 | ||||||||
| FaxNumber: | 6416287241 | ||||||||
| Practice Location | |||||||||
| Address1: | 2611 WASHINGTON ST | ||||||||
| Address2: | |||||||||
| City: | PELLA | ||||||||
| State: | IA | ||||||||
| PostalCode: | 502197924 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 6416289599 | ||||||||
| FaxNumber: | |||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 12/21/2012 | ||||||||
| LastUpdateDate: | 02/25/2019 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 104100000X | 04215 | IA | N | Behavioral Health & Social Service Providers | Social Worker | 1041C0700X | 04215 | IA | Y | Behavioral Health & Social Service Providers | Social Worker | Clinical |
ID Information
| ID | Type | State | Issuer | Description | 04215 | 01 | IA | IOWA LICENSE | OTHER |