Provider Demographics
NPI:1891755906
Name:ELBERT, JULIE A (LISW)
Entity type:Individual
Prefix:MS
First Name:JULIE
Middle Name:A
Last Name:ELBERT
Suffix:
Gender:F
Credentials:LISW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1601 MILITARY ROAD
Mailing Address - Street 2:
Mailing Address - City:SIOUX CITY
Mailing Address - State:IA
Mailing Address - Zip Code:51103
Mailing Address - Country:US
Mailing Address - Phone:712-252-4547
Mailing Address - Fax:712-252-3785
Practice Address - Street 1:1601 MILITARY ROAD
Practice Address - Street 2:
Practice Address - City:SIOUX CITY
Practice Address - State:IA
Practice Address - Zip Code:51103
Practice Address - Country:US
Practice Address - Phone:712-252-4547
Practice Address - Fax:712-252-3785
Is Sole Proprietor?:No
Enumeration Date:2006-03-23
Last Update Date:2014-09-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IA030011041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
IA0220707Medicaid
IA0220707Medicaid