Healthcare Provider Details

I. General information

NPI: 1104751502
Provider Name (Legal Business Name): SARAH JOANN ANDERSON
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

Provider Other Name: SARAH JOANN BRYANT

II. Dates (important events)

Enumeration Date: 06/16/2026
Last Update Date: 06/16/2026
Certification Date: 06/16/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

65325 CLINE FALLS RD
BEND OR
97703-8166
US

IV. Provider business mailing address

6813 NW GERKE RD
PRINEVILLE OR
97754-8082
US

V. Phone/Fax

Practice location:
  • Phone: 541-382-9410
  • Fax:
Mailing address:
  • Phone: 541-675-5743
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101Y00000X
TaxonomyCounselor
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: