Individual
CAMILLE RENEE JUNTUNEN
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
MA,CCC/SLP
Contact information
Practice address
1675 SW MARLOW AVE STE 200, PORTLAND, OR 97225-5102
(503) 228-6479
(503) 228-4248
Mailing address
1675 SW MARLOW AVE STE 200, PORTLAND, OR 97225-5102
(503) 228-6479
(503) 228-4248
Taxonomy
Speciality
Code
Description
License number
State
235Z00000X
Speech-Language Pathologist
Primary
12173
OR
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
026648000
BCBS
OR
05
—
226618
—
OR
01
—
930838454
TAX ID #
OR
01
—
A003
TRICARE ID#
OR
01
—
B060403
PACIFICSOURCE ID#
OR
Enumeration date
05/17/2006
Last updated
12/03/2013
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