Provider Demographics
NPI:1316285943
Name:ENGSTROM, JUSTIN S (MS)
Entity type:Individual
Prefix:MR
First Name:JUSTIN
Middle Name:S
Last Name:ENGSTROM
Suffix:
Gender:M
Credentials:MS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:33589 HIGH SCHOOL WAY
Mailing Address - Street 2:
Mailing Address - City:SCAPPOOSE
Mailing Address - State:OR
Mailing Address - Zip Code:97056-3326
Mailing Address - Country:US
Mailing Address - Phone:971-290-8132
Mailing Address - Fax:503-543-3796
Practice Address - Street 1:33589 HIGH SCHOOL WAY
Practice Address - Street 2:
Practice Address - City:SCAPPOOSE
Practice Address - State:OR
Practice Address - Zip Code:97056-3326
Practice Address - Country:US
Practice Address - Phone:971-290-8132
Practice Address - Fax:503-543-3796
Is Sole Proprietor?:No
Enumeration Date:2013-01-16
Last Update Date:2024-04-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OR101Y00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101Y00000XBehavioral Health & Social Service ProvidersCounselor