Healthcare Provider Details

I. General information

NPI: 1578492799
Provider Name (Legal Business Name): EMILY ROSE GROSSBERG LPC
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 05/14/2026
Last Update Date: 10/11/2026
Certification Date: 10/11/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

905 SE 14TH AVE
PORTLAND OR
97214-2549
US

IV. Provider business mailing address

905 SE 14TH AVE
PORTLAND OR
97214-2549
US

V. Phone/Fax

Practice location:
  • Phone: 503-622-8964
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YP2500X
TaxonomyProfessional Counselor
License NumberR9758
License Number StateOR

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: