Basic Information
| Provider Information | |||||||||
| NPI: | 1124271754 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | GRUENER | ||||||||
| FirstName: | SHAUNA | ||||||||
| MiddleName: | LEANNE | ||||||||
| NamePrefix: | MRS. | ||||||||
| NameSuffix: | |||||||||
| Credential: | MAT | ||||||||
| OtherOrganizationName: | |||||||||
| OtherOrganizationType: | |||||||||
| OtherLastName: | NEIL | ||||||||
| OtherFirstName: | SHAUNA | ||||||||
| OtherMiddleName: | LEANNE | ||||||||
| OtherNamePrefix: | MISS | ||||||||
| OtherNameSuffix: | |||||||||
| OtherCredential: | |||||||||
| OtherLastNameType: | 1 | ||||||||
| Mailing Information | |||||||||
| Address1: | 38730 DEXTER RD | ||||||||
| Address2: | |||||||||
| City: | DEXTER | ||||||||
| State: | OR | ||||||||
| PostalCode: | 974319797 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 5419372307 | ||||||||
| FaxNumber: | |||||||||
| Practice Location | |||||||||
| Address1: | 37875 JASPER LOWELL RD | ||||||||
| Address2: | |||||||||
| City: | JASPER | ||||||||
| State: | OR | ||||||||
| PostalCode: | 974389751 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 5417471235 | ||||||||
| FaxNumber: | |||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 10/28/2008 | ||||||||
| LastUpdateDate: | 10/28/2008 | ||||||||
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| NPIReactivationDate: | |||||||||
| ProviderGenderCode: | F | ||||||||
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| AuthorizedOfficialFirstName: | |||||||||
| AuthorizedOfficialMiddleName: | |||||||||
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| AuthorizedOfficialTelephone: | |||||||||
| IsSoleProprietor: | N | ||||||||
| IsOrganizationSubpart: | |||||||||
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| NPICertificationDate: | |||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 101YM0800X | Y | Behavioral Health & Social Service Providers | Counselor | Mental Health |
No ID Information.