Provider Demographics
NPI:1558520924
Name:HARGRAVES, JULIE A (MSW)
Entity Type:Individual
Prefix:
First Name:JULIE
Middle Name:A
Last Name:HARGRAVES
Suffix:
Gender:F
Credentials:MSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2371 NE STEPHENS STREET
Mailing Address - Street 2:SUITE 200
Mailing Address - City:ROSEBURG
Mailing Address - State:OR
Mailing Address - Zip Code:97470-1399
Mailing Address - Country:US
Mailing Address - Phone:541-672-8533
Mailing Address - Fax:541-672-4993
Practice Address - Street 1:2371 NE STEPHENS STREET
Practice Address - Street 2:SUITE 200
Practice Address - City:ROSEBURG
Practice Address - State:OR
Practice Address - Zip Code:97470-1399
Practice Address - Country:US
Practice Address - Phone:541-672-8533
Practice Address - Fax:541-672-4993
Is Sole Proprietor?:No
Enumeration Date:2008-06-02
Last Update Date:2014-12-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ORL62311041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
OR165772Medicaid