Provider Demographics
NPI:1821498908
Name:GROEBNER, REBECCA DAWN (DAC, LAC)
Entity Type:Individual
Prefix:DR
First Name:REBECCA
Middle Name:DAWN
Last Name:GROEBNER
Suffix:
Gender:F
Credentials:DAC, LAC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6427 NE 8TH AVE
Mailing Address - Street 2:
Mailing Address - City:PORTLAND
Mailing Address - State:OR
Mailing Address - Zip Code:97211-3607
Mailing Address - Country:US
Mailing Address - Phone:503-575-5499
Mailing Address - Fax:971-229-8922
Practice Address - Street 1:1235 SE DIVISION ST STE 106A
Practice Address - Street 2:
Practice Address - City:PORTLAND
Practice Address - State:OR
Practice Address - Zip Code:97202-1042
Practice Address - Country:US
Practice Address - Phone:503-575-5499
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2014-08-26
Last Update Date:2023-10-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ORAC156285171100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171100000XOther Service ProvidersAcupuncturist
Provider Identifiers
StateIdentifier IDID TypeIssuer
OR1063817450OtherGROUP NPI
OR500676108Medicaid