Healthcare Provider Details

I. General information

NPI: 1265662134
Provider Name (Legal Business Name): JULIE RAMISCH PH.D.
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 07/24/2009
Last Update Date: 03/23/2022
Certification Date: 03/23/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

260 SW MADISON AVE STE 107
CORVALLIS OR
97333-4728
US

IV. Provider business mailing address

PO BOX 2298
CORVALLIS OR
97339-2298
US

V. Phone/Fax

Practice location:
  • Phone: 541-557-1892
  • Fax:
Mailing address:
  • Phone: 805-570-4160
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code106H00000X
TaxonomyMarriage & Family Therapist
License Number4101006414
License Number StateMI
# 2
Primary TaxonomyN
Taxonomy Code106H00000X
TaxonomyMarriage & Family Therapist
License Number166.000892
License Number StateIL
# 3
Primary TaxonomyY
Taxonomy Code106H00000X
TaxonomyMarriage & Family Therapist
License NumberT1160
License Number StateOR

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: