Provider Demographics
NPI:1710533393
Name:ANDERSON, JULIANNE MICHELLE (LMT)
Entity Type:Individual
Prefix:
First Name:JULIANNE
Middle Name:MICHELLE
Last Name:ANDERSON
Suffix:
Gender:F
Credentials:LMT
Other - Prefix:
Other - First Name:JULIANNE
Other - Middle Name:MICHELLE
Other - Last Name:KLASSEN
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:3220 NW 185TH AVE STE 100
Mailing Address - Street 2:
Mailing Address - City:PORTLAND
Mailing Address - State:OR
Mailing Address - Zip Code:97229-3492
Mailing Address - Country:US
Mailing Address - Phone:971-217-7554
Mailing Address - Fax:
Practice Address - Street 1:3220 NW 185TH AVE STE 100
Practice Address - Street 2:
Practice Address - City:PORTLAND
Practice Address - State:OR
Practice Address - Zip Code:97229-3492
Practice Address - Country:US
Practice Address - Phone:971-217-7554
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2019-08-10
Last Update Date:2022-01-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OR24263225700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage Therapist