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Individual
JULIE A SUPPLE
Active
Individual
JULIE A SUPPLE
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
LCSW
Taxonomy
Speciality
Code
Description
License number
State
104100000X
Social Worker
34003062A
IN
1041C0700X
Clinical Social Worker
Primary
34003062A
IN
Other
Enumeration date
03/14/2012
Last updated
03/14/2012
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