Healthcare Provider Details

I. General information

NPI: 1558118844
Provider Name (Legal Business Name): JULIE SLIGA LPC
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 05/03/2024
Last Update Date: 07/14/2024
Certification Date: 07/14/2024
Deactivation Date: 05/03/2024
Reactivation Date: 06/03/2024

III. Provider practice location address

4417 NE KILLINGSWORTH ST UNIT 112
PORTLAND OR
97218-1471
US

IV. Provider business mailing address

4417 NE KILLINGSWORTH ST UNIT 112
PORTLAND OR
97218-1471
US

V. Phone/Fax

Practice location:
  • Phone: 503-694-9600
  • Fax:
Mailing address:
  • Phone: 503-694-9600
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code225C00000X
TaxonomyRehabilitation Counselor
License Number00109113
License Number State
# 2
Primary TaxonomyY
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License NumberC8453
License Number StateOR

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: