MEDICARE: JULIANNE BALTZLEY

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	101YM0800X	Mental Health Counselor

General Provider Information

NPI Number	:	1023461019
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	JULIANNE BALTZLEY

Provider Business Mailing Address
First Line	:	3587 HEATHROW WAY
Second Line	:
City	:	MEDFORD
State	:	OR
Zip	:	97504-4004
Country	:	US
Telephone Number	:	916-917-8474
Fax Number	:

Provider Business Practice Location Address
First Line	:	2409 SE 149TH AVENUE
Second Line	:
City	:	PORTLAND
State	:	OR
Zip	:	97233
Country	:	US
Telephone Number	:	971-302-6256
Fax Number	:	971-302-6257

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	07/14/2016
Last Update Date	:	07/14/2016

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Directions to “ JULIANNE BALTZLEY ” Practice Location

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