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NPI Code Detail

MEDICARE: CAMILLE RENEE JUNTUNEN MA,CCC/SLP

MEDICARE:   CAMILLE RENEE JUNTUNEN  MA,CCC/SLP
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
1235Z00000XSpeech-Language Pathologist12173OR

Other Identifiers

# Provider Identifier Provider Identifier Type Provider Identifier State Provider Identifier Issuer
1MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
2026648000OTHERORBCBS
3B060403OTHERORPACIFICSOURCE ID#
4A003OTHERORTRICARE ID#
5930838454OTHERORTAX ID #

General Provider Information

NPI Number : 1609828730
Entity Type Code : Individual
Provider Name (Legal Business Name) : CAMILLE RENEE JUNTUNEN MA,CCC/SLP
Provider Business Mailing Address
First Line : 1675 SW MARLOW AVE STE 200
Second Line :
City : PORTLAND
State : OR
Zip : 97225-5102
Country : US
Telephone Number : 503-228-6479
Fax Number : 503-228-4248
Provider Business Practice Location Address
First Line : 1675 SW MARLOW AVE STE 200
Second Line :
City : PORTLAND
State : OR
Zip : 97225-5102
Country : US
Telephone Number : 503-228-6479
Fax Number : 503-228-4248
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 05/17/2006
Last Update Date : 12/03/2013

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Directions to “ CAMILLE RENEE JUNTUNEN MA,CCC/SLP” Practice Location

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