Healthcare Provider Details

I. General information

NPI: 1376202242
Provider Name (Legal Business Name): SHERI JENISE BANSEMER LPC, NCC
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 12/08/2021
Last Update Date: 08/27/2026
Certification Date: 08/27/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

360 NW VERMONT ST STE 50
BEND OR
97703-1945
US

IV. Provider business mailing address

360 NW VERMONT ST STE 50
BEND OR
97703-1945
US

V. Phone/Fax

Practice location:
  • Phone: 541-728-3896
  • Fax:
Mailing address:
  • Phone: 541-728-3896
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YP2500X
TaxonomyProfessional Counselor
License NumberC8738
License Number StateOR

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: