Provider Demographics
NPI:1699431627
Name:RAUTIOLA, MARK
Entity type:Individual
Prefix:
First Name:MARK
Middle Name:
Last Name:RAUTIOLA
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:825 E 10TH ST APT C
Mailing Address - Street 2:
Mailing Address - City:MEDFORD
Mailing Address - State:OR
Mailing Address - Zip Code:97504-7921
Mailing Address - Country:US
Mailing Address - Phone:978-473-9663
Mailing Address - Fax:
Practice Address - Street 1:6975 SW SANDBURG ST STE 200
Practice Address - Street 2:
Practice Address - City:TIGARD
Practice Address - State:OR
Practice Address - Zip Code:97223-8089
Practice Address - Country:US
Practice Address - Phone:978-473-9663
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2021-11-15
Last Update Date:2021-11-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ORC6330101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health