Provider Demographics
NPI:1154600393
Name:AUSTIN, JULIA KRISTI (LCSW)
Entity type:Individual
Prefix:MS
First Name:JULIA
Middle Name:KRISTI
Last Name:AUSTIN
Suffix:
Gender:F
Credentials:LCSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 934
Mailing Address - Street 2:
Mailing Address - City:WILLIAMS BAY
Mailing Address - State:WI
Mailing Address - Zip Code:53191-0934
Mailing Address - Country:US
Mailing Address - Phone:262-745-6970
Mailing Address - Fax:
Practice Address - Street 1:93 W GENEVA ST
Practice Address - Street 2:
Practice Address - City:WILLIAMS BAY
Practice Address - State:WI
Practice Address - Zip Code:53191-9518
Practice Address - Country:US
Practice Address - Phone:262-607-6390
Practice Address - Fax:262-607-6387
Is Sole Proprietor?:Yes
Enumeration Date:2011-08-05
Last Update Date:2017-11-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL1490149781041C0700X
1041S0200X
WI88091041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
No1041S0200XBehavioral Health & Social Service ProvidersSocial WorkerSchool