Provider Demographics
NPI:1700027968
Name:GRUNDE, SHERYL NAOMI
Entity Type:Individual
Prefix:MS
First Name:SHERYL
Middle Name:NAOMI
Last Name:GRUNDE
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:7 HIDDEN LN
Mailing Address - Street 2:
Mailing Address - City:ASHLAND
Mailing Address - State:OR
Mailing Address - Zip Code:97520-9572
Mailing Address - Country:US
Mailing Address - Phone:541-951-7474
Mailing Address - Fax:
Practice Address - Street 1:7 HIDDEN LN
Practice Address - Street 2:
Practice Address - City:ASHLAND
Practice Address - State:OR
Practice Address - Zip Code:97520-9572
Practice Address - Country:US
Practice Address - Phone:541-951-7474
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2009-03-18
Last Update Date:2023-03-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
101YM0800X
OR15681172V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health
No172V00000XOther Service ProvidersCommunity Health Worker