Provider Demographics
NPI:1083470959
Name:BIGELOW, MARJEAN GUTZMAN (MASTERSSTUDENTINTERN)
Entity Type:Individual
Prefix:
First Name:MARJEAN
Middle Name:GUTZMAN
Last Name:BIGELOW
Suffix:
Gender:F
Credentials:MASTERSSTUDENTINTERN
Other - Prefix:
Other - First Name:MARJEAN
Other - Middle Name:
Other - Last Name:GUTZMAN
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:615 N MEADOW LN
Mailing Address - Street 2:
Mailing Address - City:SISTERS
Mailing Address - State:OR
Mailing Address - Zip Code:97759-3148
Mailing Address - Country:US
Mailing Address - Phone:541-640-9310
Mailing Address - Fax:360-326-1978
Practice Address - Street 1:704 W HOOD AVE STE D
Practice Address - Street 2:
Practice Address - City:SISTERS
Practice Address - State:OR
Practice Address - Zip Code:97759-1529
Practice Address - Country:US
Practice Address - Phone:541-640-9310
Practice Address - Fax:360-326-1978
Is Sole Proprietor?:No
Enumeration Date:2024-02-27
Last Update Date:2024-03-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health