Provider Demographics
NPI:1588608319
Name:REDNER, JULIE E (PHD)
Entity Type:Individual
Prefix:
First Name:JULIE
Middle Name:E
Last Name:REDNER
Suffix:
Gender:F
Credentials:PHD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 24410
Mailing Address - Street 2:
Mailing Address - City:EUGENE
Mailing Address - State:OR
Mailing Address - Zip Code:97402-0451
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:1162 WILLAMETTE ST
Practice Address - Street 2:
Practice Address - City:EUGENE
Practice Address - State:OR
Practice Address - Zip Code:97401-3568
Practice Address - Country:US
Practice Address - Phone:541-687-5609
Practice Address - Fax:541-687-6214
Is Sole Proprietor?:No
Enumeration Date:2006-06-15
Last Update Date:2007-11-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OR1198103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
OR077508Medicaid
R09469Medicare UPIN
ORRR PTAN P00093861Medicare PIN
OR077508Medicaid