Healthcare Provider Details

I. General information

NPI: 1962108217
Provider Name (Legal Business Name): MS. VANESSA LAREE HANSLITS
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: VANESSA LAREE EATON

II. Dates (important events)

Enumeration Date: 02/07/2023
Last Update Date: 05/09/2026
Certification Date: 05/09/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

300 SE REED MARKET RD
BEND OR
97702-3814
US

IV. Provider business mailing address

300 SE REED MARKET RD
BEND OR
97702-3814
US

V. Phone/Fax

Practice location:
  • Phone: 970-846-7545
  • Fax:
Mailing address:
  • Phone: 541-204-0385
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License Number
License Number State
# 2
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: