Provider Demographics
NPI:1659878742
Name:SILVER BIRCH THERAPY PLLC
Entity Type:Organization
Organization Name:SILVER BIRCH THERAPY PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:AMY
Authorized Official - Middle Name:
Authorized Official - Last Name:VREDENBURGH
Authorized Official - Suffix:
Authorized Official - Credentials:MA, LMFT
Authorized Official - Phone:612-876-6586
Mailing Address - Street 1:9450 SW GEMINI DR
Mailing Address - Street 2:PMB 14034
Mailing Address - City:BEAVERTON
Mailing Address - State:OR
Mailing Address - Zip Code:97008-5842
Mailing Address - Country:US
Mailing Address - Phone:612-876-6586
Mailing Address - Fax:
Practice Address - Street 1:905 STANLEY AVE
Practice Address - Street 2:
Practice Address - City:CLOQUET
Practice Address - State:MN
Practice Address - Zip Code:55720-3186
Practice Address - Country:US
Practice Address - Phone:612-876-6586
Practice Address - Fax:185-851-5862
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2018-04-06
Last Update Date:2021-06-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MN2962106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family TherapistGroup - Single Specialty