Provider Demographics
NPI:1427689868
Name:DORNEMAN, JULIE HARLESS
Entity type:Individual
Prefix:
First Name:JULIE
Middle Name:HARLESS
Last Name:DORNEMAN
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 1:3617 W 200 S
Mailing Address - Street 2:
Mailing Address - City:RUSSIAVILLE
Mailing Address - State:IN
Mailing Address - Zip Code:46979-9139
Mailing Address - Country:US
Mailing Address - Phone:765-398-0271
Mailing Address - Fax:
Practice Address - Street 1:3617 W 200 S
Practice Address - Street 2:
Practice Address - City:RUSSIAVILLE
Practice Address - State:IN
Practice Address - Zip Code:46979-9139
Practice Address - Country:US
Practice Address - Phone:765-398-0271
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2020-02-03
Last Update Date:2020-02-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN34008489A1041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical