Provider Demographics
NPI:1205396108
Name:SIEGFRIED, JULIANA JILL (MS)
Entity Type:Individual
Prefix:
First Name:JULIANA
Middle Name:JILL
Last Name:SIEGFRIED
Suffix:
Gender:F
Credentials:MS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:66 CLUB RD STE 350
Mailing Address - Street 2:
Mailing Address - City:EUGENE
Mailing Address - State:OR
Mailing Address - Zip Code:97401-2599
Mailing Address - Country:US
Mailing Address - Phone:541-343-1728
Mailing Address - Fax:
Practice Address - Street 1:66 CLUB RD STE 350
Practice Address - Street 2:
Practice Address - City:EUGENE
Practice Address - State:OR
Practice Address - Zip Code:97401-2599
Practice Address - Country:US
Practice Address - Phone:541-343-1728
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2019-03-25
Last Update Date:2022-09-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ORR5687101YP2500X, 101Y00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional
No101Y00000XBehavioral Health & Social Service ProvidersCounselor