Healthcare Provider Details

I. General information

NPI: 1104657964
Provider Name (Legal Business Name): SHERYL S RUETTGERS MA, LPC
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 08/12/2024
Last Update Date: 08/21/2026
Certification Date: 08/21/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

220 S PINE ST STE 209
SISTERS OR
97759-1679
US

IV. Provider business mailing address

16837 GOLDEN STONE DR
SISTERS OR
97759-9696
US

V. Phone/Fax

Practice location:
  • Phone: 458-206-1860
  • Fax:
Mailing address:
  • Phone: 458-206-1860
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License NumberC10199
License Number StateOR

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: