Provider Demographics
NPI:1881235406
Name:EGGEN, JULIA ROSE (CRM)
Entity type:Individual
Prefix:
First Name:JULIA
Middle Name:ROSE
Last Name:EGGEN
Suffix:
Gender:F
Credentials:CRM
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1122 NE 122ND AVE STE A102
Mailing Address - Street 2:
Mailing Address - City:PORTLAND
Mailing Address - State:OR
Mailing Address - Zip Code:97230-2082
Mailing Address - Country:US
Mailing Address - Phone:855-237-9882
Mailing Address - Fax:
Practice Address - Street 1:1122 NE 122ND AVE STE A102
Practice Address - Street 2:
Practice Address - City:PORTLAND
Practice Address - State:OR
Practice Address - Zip Code:97230-2082
Practice Address - Country:US
Practice Address - Phone:855-237-9882
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2019-10-04
Last Update Date:2019-10-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)