Provider Demographics
NPI:1821553322
Name:CHURCHILL, JANELLE NAOMI (BSW ICM)
Entity Type:Individual
Prefix:
First Name:JANELLE
Middle Name:NAOMI
Last Name:CHURCHILL
Suffix:
Gender:F
Credentials:BSW ICM
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5716 SW HAMILTON ST APT B
Mailing Address - Street 2:
Mailing Address - City:PORTLAND
Mailing Address - State:OR
Mailing Address - Zip Code:97221-2072
Mailing Address - Country:US
Mailing Address - Phone:253-508-2515
Mailing Address - Fax:
Practice Address - Street 1:8041 E BURNSIDE ST
Practice Address - Street 2:
Practice Address - City:PORTLAND
Practice Address - State:OR
Practice Address - Zip Code:97215-1548
Practice Address - Country:US
Practice Address - Phone:503-252-3304
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2019-02-08
Last Update Date:2019-02-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes104100000XBehavioral Health & Social Service ProvidersSocial Worker