Julie Anne De Wilde, M.A., LPCC

Primary specialty

Professional CounselorTaxonomy code 101YP2500X

License

CC01711 Issued in MN

Practice address

1900 Silver Lake Rd NW
New Brighton, MN 55112-1786

Phone

(651) 628-9566

NPI assigned

Aug 3, 2016

Sex

Female

Sole proprietor

No

Registry information is reported by the provider to CMS and is not verified. About this source

Specialties & licenses 1

Addresses

Medicare fee-for-service enrollment

Enrolled in MN

Eligible to order & refer

• Part B services: Yes
• Medical equipment: Yes
• Home health: No
• Power mobility devices: No
• Hospice: No

Green means eligible to order or refer.

Enrollment records 1

Specialty

Mental Health Counselor

Education

Other, 1999

Medicare assignment

May accept Medicare assignment

Telehealth

Offers telehealth services

Group practices

Rush IncGroup PAC ID 8224131750, 19 clinicians

Practice addresses (Care Compare)

Medicare enrollment (NPD)

Enrolled

Credentials

Master of Arts

State licenses

Practice roles

Locations

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships and National Provider Directory roles.

• Rush Inc

  • Psychologist
  • Stillwater, MN
  • NPI 1801942040
  Medicare reassignment Care Compare group NPD

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1470182400000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1516320000000",
    "number": "1083168314",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1900 SILVER LAKE RD NW",
            "city": "NEW BRIGHTON",
            "state": "MN",
            "postal_code": "551121786",
            "telephone_number": "651-628-9566"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1900 SILVER LAKE RD NW",
            "city": "NEW BRIGHTON",
            "state": "MN",
            "postal_code": "551121786",
            "telephone_number": "651-628-9566"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "DE WILDE",
        "first_name": "JULIE",
        "middle_name": "ANNE",
        "name_prefix": "Mrs.",
        "credential": "M.A., LPCC",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2016-08-03",
        "last_updated": "2018-01-19",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "101YP2500X",
            "taxonomy_group": "",
            "desc": "Counselor, Professional",
            "state": "MN",
            "license": "CC01711",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Dakota Therapy
• Enesy Stepanovna Daskalyuk
• Esther Davis
• Jessica Davis, PSYD LP
• Kaleah Rose Davis, LADC
• Mason Alan Decambaliza
• Amanda Dekanick
• Kathrynne Delgado, MS, MA, LMFT
• Marsha Dettloff
• Dialysis Access of Minnesota, L.L.C.

• Professional Counselor in New Brighton, MN
• Providers in New Brighton, MN by specialty
• Professional Counselor in Minnesota

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jan 19, 2018; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments; Order and Referring.
• Medicare Care Compare (CMS): clinician profile, group practices, facility affiliations, MIPS scores and star ratings.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.