Provider Demographics
NPI:1871935403
Name:DINEEN, JULIE ANN (RTT)
Entity type:Individual
Prefix:MRS
First Name:JULIE
Middle Name:ANN
Last Name:DINEEN
Suffix:
Gender:F
Credentials:RTT
Other - Prefix:MISS
Other - First Name:JULIE
Other - Middle Name:ANN
Other - Last Name:LAKOTA
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:RTT
Mailing Address - Street 1:17750 KEDZIE AVE
Mailing Address - Street 2:
Mailing Address - City:HAZEL CREST
Mailing Address - State:IL
Mailing Address - Zip Code:60429-2047
Mailing Address - Country:US
Mailing Address - Phone:708-799-9995
Mailing Address - Fax:708-799-8129
Practice Address - Street 1:17750 KEDZIE AVE
Practice Address - Street 2:
Practice Address - City:HAZEL CREST
Practice Address - State:IL
Practice Address - Zip Code:60429-2047
Practice Address - Country:US
Practice Address - Phone:708-799-9995
Practice Address - Fax:708-799-8129
Is Sole Proprietor?:No
Enumeration Date:2013-07-24
Last Update Date:2013-07-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL500482171247100000X
IL5004837272471R0002X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2471R0002XTechnologists, Technicians & Other Technical Service ProvidersRadiologic TechnologistRadiation Therapy
No247100000XTechnologists, Technicians & Other Technical Service ProvidersRadiologic Technologist