Healthcare Provider Details

I. General information

NPI: 1346883071
Provider Name (Legal Business Name): HEATHER GRANDIS-FERRETTI
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 10/25/2019
Last Update Date: 06/01/2021
Certification Date: 06/01/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

182 SW ACADEMY ST
DALLAS OR
97338-1996
US

IV. Provider business mailing address

4585 SW 185TH AVE
ALOHA OR
97078-1557
US

V. Phone/Fax

Practice location:
  • Phone: 503-623-9289
  • Fax:
Mailing address:
  • Phone: 503-591-9280
  • Fax: 503-848-2072

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: