Healthcare Provider Details

I. General information

NPI: 1659639938
Provider Name (Legal Business Name): MRS. JULIE RUUD
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/24/2012
Last Update Date: 04/24/2012
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

15050 SW KOLL PKWY STE G
BEAVERTON OR
97006-6002
US

IV. Provider business mailing address

15050 SW KOLL PKWY STE G
BEAVERTON OR
97006-6002
US

V. Phone/Fax

Practice location:
  • Phone: 503-439-9494
  • Fax:
Mailing address:
  • Phone: 503-439-9494
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225500000X
TaxonomyRespiratory/Developmental/Rehabilitative Specialist/Technologist
License Number5380
License Number StateOR

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: