Provider Demographics
NPI:1821508086
Name:JULIE S. O'DONNELL
Entity Type:Organization
Organization Name:JULIE S. O'DONNELL
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CLINICAL SOCIAL WORKER
Authorized Official - Prefix:
Authorized Official - First Name:JULIE
Authorized Official - Middle Name:SUZANNE
Authorized Official - Last Name:O'DONNELL
Authorized Official - Suffix:
Authorized Official - Credentials:LCSW
Authorized Official - Phone:971-404-6504
Mailing Address - Street 1:PO BOX 644
Mailing Address - Street 2:
Mailing Address - City:MOSIER
Mailing Address - State:OR
Mailing Address - Zip Code:97040-0644
Mailing Address - Country:US
Mailing Address - Phone:971-404-6504
Mailing Address - Fax:
Practice Address - Street 1:509 CASCADE AVE
Practice Address - Street 2:
Practice Address - City:HOOD RIVER
Practice Address - State:OR
Practice Address - Zip Code:97031-2060
Practice Address - Country:US
Practice Address - Phone:971-404-6504
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2017-10-02
Last Update Date:2017-10-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ORL6408251S00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251S00000XAgenciesCommunity/Behavioral Health