Healthcare Provider Details

I. General information

NPI: 1255602330
Provider Name (Legal Business Name): TERESA DAWN VEVERKA MSW
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: TERESA BULLOCK VEVERKA MSW

II. Dates (important events)

Enumeration Date: 01/20/2012
Last Update Date: 08/24/2026
Certification Date: 08/24/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2855 NW CROSSING DR STE 202
BEND OR
97703-7049
US

IV. Provider business mailing address

5441 S MACADAM AVE STE R
PORTLAND OR
97239-3822
US

V. Phone/Fax

Practice location:
  • Phone: 541-722-8854
  • Fax:
Mailing address:
  • Phone: 541-722-8854
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License NumberL18196
License Number StateOR
# 2
Primary TaxonomyN
Taxonomy Code104100000X
TaxonomySocial Worker
License NumberA4507
License Number StateOR

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: