Healthcare Provider Details

I. General information

NPI: 1962711150
Provider Name (Legal Business Name): SIERRA GROENEWOLD LPC
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 10/05/2010
Last Update Date: 09/30/2026
Certification Date: 09/30/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2084 NE PROFESSIONAL CT
BEND OR
97701-6077
US

IV. Provider business mailing address

PO BOX 4228
PORTLAND OR
97208-4228
US

V. Phone/Fax

Practice location:
  • Phone: 541-383-3005
  • Fax: 541-383-1883
Mailing address:
  • Phone: 541-617-5369
  • Fax: 541-323-3866

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License NumberC3377
License Number StateOR
# 2
Primary TaxonomyN
Taxonomy Code101YP2500X
TaxonomyProfessional Counselor
License NumberC3377
License Number StateOR

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: