Individual ProviderJulie Gardner KallenbornCounselorBehavioral Health & Social Service ProvidersPractice Address11035 NE Sandy Blvd, Portland, OR 97220-2553(503) 258-4200PECOS EnrollmentBased on the most recent information from CMS, provider Julie Gardner Kallenborn does not have current enrollment records in PECOS.Part BMedicare Part BNot EnrolledHHAHome Health AgencyNot EnrolledDMEDurable Medical EquipmentNot EnrolledPMDPower Mobility DeviceNot EnrolledCMS last updated its PECOS records 2 days ago.Profile DetailsProvider ID1538619531Provider TypeIndividualFull NameKallenborn, Julie GardnerGenderFemaleSole ProprietorYesEnumeration Date10/13/2016Last Updated11/21/2016Contact InformationPractice LocationPractice Address11035 NE Sandy Blvd, Portland, OR 97220-2553Phone(503) 258-4200FaxUnlisted FaxMailing LocationMailing Address11035 NE Sandy Blvd, Portland, OR 97220-2553Phone(503) 258-4200FaxUnlisted FaxProvider TaxonomiesCodeDescriptionLicenseCode101YM0800XPrimaryDescriptionCounselorBehavioral Health & Social Service ProvidersLicenseC.1500359OhioCode101YA0400XDescriptionCounselorBehavioral Health & Social Service ProvidersLicenseC.1500359Ohio