Provider Demographics
NPI:1780706085
Name:RIUTZEL, JULIA E (MA)
Entity type:Individual
Prefix:
First Name:JULIA
Middle Name:E
Last Name:RIUTZEL
Suffix:
Gender:F
Credentials:MA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:31601 RABBIT RUN LN
Mailing Address - Street 2:
Mailing Address - City:LEBANON
Mailing Address - State:OR
Mailing Address - Zip Code:97355-8920
Mailing Address - Country:US
Mailing Address - Phone:541-405-2338
Mailing Address - Fax:
Practice Address - Street 1:620 NW VAN BUREN AVE STE 9
Practice Address - Street 2:
Practice Address - City:CORVALLIS
Practice Address - State:OR
Practice Address - Zip Code:97330-4846
Practice Address - Country:US
Practice Address - Phone:541-207-3958
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-04-06
Last Update Date:2022-05-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AK819101YP2500X
ORC2535101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional
Provider Identifiers
StateIdentifier IDID TypeIssuer
OR500679096Medicaid