Mary K Sperduto

Primary specialty

Mental Health CounselorTaxonomy code 101YM0800X

License

C9205 Issued in OR

Practice address

1011 SW Emkay Dr Ste 104
Bend, OR 97702-3162

Phone

(541) 323-3477

NPI assigned

Jun 28, 2021

Sex

Female

Sole proprietor

Yes

Registry information is reported by the provider to CMS and is not verified. About this source

Specialties & licenses 2

Addresses

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Opted out of Medicare

Yes, effective Jul 2, 2026 through Jul 2, 2028

Medicare enrollment (NPD)

Not enrolled

State licenses

Practice roles

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships and National Provider Directory roles.

• Rimrock Trails Treatment Services

  • Children's Substance Abuse Rehabilitation Facility
  • Prineville, OR
  • NPI 1194873406
  NPD (past)

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1624838400000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1732579200000",
    "number": "1134799679",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1011 SW EMKAY DR STE 104",
            "city": "BEND",
            "state": "OR",
            "postal_code": "977023162",
            "telephone_number": "541-323-3477",
            "fax_number": "541-447-2616"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1011 SW EMKAY DR STE 104",
            "city": "BEND",
            "state": "OR",
            "postal_code": "977023162",
            "telephone_number": "541-323-3477"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "SPERDUTO",
        "first_name": "MARY",
        "middle_name": "K",
        "sole_proprietor": "YES",
        "sex": "F",
        "enumeration_date": "2021-06-28",
        "last_updated": "2024-11-26",
        "certification_date": "2024-11-26",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "101YM0800X",
            "taxonomy_group": "",
            "desc": "Counselor, Mental Health",
            "state": null,
            "license": null,
            "primary": false
        },
        {
            "code": "101YM0800X",
            "taxonomy_group": "",
            "desc": "Counselor, Mental Health",
            "state": "OR",
            "license": "C9205",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Speech Pedals
• Willem O. Speed, MD
• Jessica Marie Spencer, LPC, CADCII
• Mark K Spencer, PA
• Robyn Spencer
• Michelle J Spetic, RN
• Thomas M Spoonster, D.D.S.
• Joshua Sprague
• Jeremiah Glen Spray
• Nicole Spreadborough

• Mental Health Counselor in Bend, OR
• Providers in Bend, OR by specialty
• Mental Health Counselor in Oregon

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Nov 26, 2024; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments; Opt Out Affidavits.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.