Provider Demographics
NPI:1225232044
Name:EHIZEMWOGIE, JULIE EBOHON (LEVEL 2 BEHAVIOR THE)
Entity type:Individual
Prefix:
First Name:JULIE
Middle Name:EBOHON
Last Name:EHIZEMWOGIE
Suffix:
Gender:F
Credentials:LEVEL 2 BEHAVIOR THE
Other - Prefix:
Other - First Name:JULIE
Other - Middle Name:EBOHON
Other - Last Name:UIWA
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:OCCUPATIONAL THERAPI
Mailing Address - Street 1:CORNERSTONE SERVICES INC
Mailing Address - Street 2:777 JOYCE ROAD
Mailing Address - City:JOLIET
Mailing Address - State:IL
Mailing Address - Zip Code:60436
Mailing Address - Country:US
Mailing Address - Phone:773-574-4730
Mailing Address - Fax:815-744-6916
Practice Address - Street 1:CORNERSTONE SERVICES INC
Practice Address - Street 2:777 JOYCE ROAD
Practice Address - City:JOLIET
Practice Address - State:IL
Practice Address - Zip Code:60436
Practice Address - Country:US
Practice Address - Phone:773-574-4730
Practice Address - Fax:815-744-6916
Is Sole Proprietor?:No
Enumeration Date:2007-06-14
Last Update Date:2025-10-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY006210224Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes224Z00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapy Assistant
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY006210Medicaid