Healthcare Provider Details

I. General information

NPI: 1881593374
Provider Name (Legal Business Name): VINCENT WILLIAM SPERDUTO
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 11/02/2026
Last Update Date: 11/02/2026
Certification Date: 11/02/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

695 SW MILL VIEW WAY
BEND OR
97702-1557
US

IV. Provider business mailing address

695 SW MILL VIEW WAY
BEND OR
97702-1557
US

V. Phone/Fax

Practice location:
  • Phone: 541-224-7003
  • Fax: 541-200-6172
Mailing address:
  • Phone: 541-224-7003
  • Fax: 541-200-6172

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YP2500X
TaxonomyProfessional Counselor
License NumberC8062
License Number StateOR

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: