MEDICARE: SHERI JENISE BANSEMER NCC

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	390200000X	Student in an Organized Health Care Education/Training Program
2	101YM0800X	Mental Health Counselor

General Provider Information

NPI Number	:	1376202242
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	SHERI JENISE BANSEMER NCC

Provider Business Mailing Address
First Line	:	360 NW VERMONT ST STE 50
Second Line	:
City	:	BEND
State	:	OR
Zip	:	97703-1945
Country	:	US
Telephone Number	:	541-728-3896
Fax Number	:

Provider Business Practice Location Address
First Line	:	360 NW VERMONT ST STE 50
Second Line	:
City	:	BEND
State	:	OR
Zip	:	97703-1945
Country	:	US
Telephone Number	:	541-728-3896
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	12/08/2021
Last Update Date	:	03/12/2026

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