Active NPI
Camille Renee Juntunen, MA,CCC/SLP
- Speech-Language Pathologist
- Portland, OR
National Provider Identifier
1609828730
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Speech-Language Pathologist
- License
- 12173
- Practice address
- 1675 SW Marlow Ave Ste 200
Portland, OR 97225-5102 - Phone
- (503) 228-6479
- Fax
- (503) 228-4248
- NPI assigned
- May 17, 2006
- Last updated
- Dec 3, 2013
- Sex
- Female
- Sole proprietor
- No
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 1
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Speech-Language Pathologist | 235Z00000X | 12173 | OR | Primary |
Addresses
Primary practice location
1675 SW Marlow Ave Ste 200
Portland, OR 97225-5102
Mailing address
1675 SW Marlow Ave Ste 200
Portland, OR 97225-5102
Phone (503) 228-6479
Other identifiers 5
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 226618 | Medicaid | OR | |
| 026648000 | Other | OR | BCBS |
| B060403 | Other | OR | PACIFICSOURCE ID# |
| A003 | Other | OR | TRICARE ID# |
| 930838454 | Other | OR | TAX ID # |
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Not enrolled
- Credentials
- Master of Arts
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 12173 | OR | MD | Pharmacist |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1147824000000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1386028800000",
"number": "1609828730",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "1675 SW MARLOW AVE STE 200",
"city": "PORTLAND",
"state": "OR",
"postal_code": "972255102",
"telephone_number": "503-228-6479",
"fax_number": "503-228-4248"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "1675 SW MARLOW AVE STE 200",
"city": "PORTLAND",
"state": "OR",
"postal_code": "972255102",
"telephone_number": "503-228-6479",
"fax_number": "503-228-4248"
}
],
"practiceLocations": [],
"basic": {
"last_name": "JUNTUNEN",
"first_name": "CAMILLE",
"middle_name": "RENEE",
"credential": "MA,CCC/SLP",
"sole_proprietor": "NO",
"sex": "F",
"enumeration_date": "2006-05-17",
"last_updated": "2013-12-03",
"status": "A"
},
"taxonomies": [
{
"code": "235Z00000X",
"taxonomy_group": "",
"desc": "Speech-Language Pathologist",
"state": "OR",
"license": "12173",
"primary": true
}
],
"identifiers": [
{
"code": "05",
"desc": "MEDICAID",
"issuer": null,
"identifier": "226618",
"state": "OR"
},
{
"code": "01",
"desc": "Other (non-Medicare)",
"issuer": "BCBS",
"identifier": "026648000",
"state": "OR"
},
{
"code": "01",
"desc": "Other (non-Medicare)",
"issuer": "PACIFICSOURCE ID#",
"identifier": "B060403",
"state": "OR"
},
{
"code": "01",
"desc": "Other (non-Medicare)",
"issuer": "TRICARE ID#",
"identifier": "A003",
"state": "OR"
},
{
"code": "01",
"desc": "Other (non-Medicare)",
"issuer": "TAX ID #",
"identifier": "930838454",
"state": "OR"
}
],
"endpoints": [],
"other_names": []
}Other providers in Portland, OR
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Dec 3, 2013; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.