Provider Demographics
NPI:1679874176
Name:LIEBE, SHERRY LEE (MSW, CSWA)
Entity type:Individual
Prefix:
First Name:SHERRY
Middle Name:LEE
Last Name:LIEBE
Suffix:
Gender:F
Credentials:MSW, CSWA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5450 NW ODIN FALLS WAY
Mailing Address - Street 2:
Mailing Address - City:REDMOND
Mailing Address - State:OR
Mailing Address - Zip Code:97756-7940
Mailing Address - Country:US
Mailing Address - Phone:503-369-9332
Mailing Address - Fax:
Practice Address - Street 1:916 SW 17TH ST SUITE 100
Practice Address - Street 2:916 SW 17TH ST SUITE 100
Practice Address - City:REDMOND
Practice Address - State:OR
Practice Address - Zip Code:97756
Practice Address - Country:US
Practice Address - Phone:541-547-2778
Practice Address - Fax:541-548-1106
Is Sole Proprietor?:No
Enumeration Date:2010-11-15
Last Update Date:2022-06-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
101YA0400X
ORA13200104100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes104100000XBehavioral Health & Social Service ProvidersSocial Worker
No101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)
Provider Identifiers
StateIdentifier IDID TypeIssuer
OR195164Medicaid