Provider Demographics
NPI:1730051087
Name:AKLILU, FITSUM ABERA
Entity type:Individual
Prefix:
First Name:FITSUM
Middle Name:ABERA
Last Name:AKLILU
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 1:12446 SE EAGLE GLEN DR
Mailing Address - Street 2:
Mailing Address - City:HAPPY VALLEY
Mailing Address - State:OR
Mailing Address - Zip Code:97086-6499
Mailing Address - Country:US
Mailing Address - Phone:971-331-0569
Mailing Address - Fax:503-698-5568
Practice Address - Street 1:11762 SE MARKET DR
Practice Address - Street 2:
Practice Address - City:CLACKAMAS
Practice Address - State:OR
Practice Address - Zip Code:97015-8674
Practice Address - Country:US
Practice Address - Phone:971-331-0569
Practice Address - Fax:503-698-5568
Is Sole Proprietor?:Yes
Enumeration Date:2025-09-18
Last Update Date:2025-09-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OR320800000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes320800000XResidential Treatment FacilitiesCommunity Based Residential Treatment Facility, Mental Illness