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Heidi Kathleen Hicinbothom
Peer Specialist in Grand Ronde, Oregon
NPI 1023534252

Heidi Kathleen Hicinbothom is a Peer Specialist based in Grand Ronde, OR. Heidi Kathleen Hicinbothom practices in Grand Ronde, OR. The NPI Number for Heidi Kathleen Hicinbothom is 1023534252 and holds a License No. T-21-874 (Oregon).

The current practice location address for Heidi Kathleen Hicinbothom is 9605 Grand Ronde Rd, Grand Ronde, OR and can be reached out via phone at 503-879-2026.

Location: 9605 Grand Ronde Rd, Grand Ronde, OR, 97347-9712
Profile Details Legacy Identifiers Practice Address Mailing Address Primary Taxonomy
person
Provider Profile Details
NPI Number
1023534252
Provider Name
Heidi Kathleen Hicinbothom
Credential
Provider Entity Type
Individual
Gender
Female
Address
9605 Grand Ronde Rd, Grand Ronde, OR, 97347-9712
Phone Number
503-879-2026
Fax Number
Provider Enumeration Date
08/18/2017
Last Update Date
03/09/2024
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Provider's Legacy Identifiers
Identifier Type State Issuer
500753908 05 OR
institution
Provider Business Practice Location Address Details
Address
9605 Grand Ronde Rd
City
Grand Ronde
State
Oregon
Zip
97347-9712
Phone Number
503-879-2026
Fax Number
person
Provider Business Mailing Address Details
Address
9605 Grand Ronde Rd
City
Grand Ronde
State
Oregon
Zip
97347-9712
Phone Number
503-879-2026
Fax Number
person
Provider's Taxonomy Details 1
Type
Behavioral Health & Social Service Providers
Classification
Counselor
Speciality
Addiction (Substance Use Disorder)
Taxonomy
101YA0400X
License No.
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Definition
Definition to come...
person
Provider's Taxonomy Details 2
Type
Other Service Providers
Classification
Peer Specialist
Speciality
-
Taxonomy
175T00000X
License No.
T-21-874 (Oregon)
Definition
Individuals certified to perform peer support services through a training process defined by a government agency, such as the Department of Veterans Affairs or a state mental health department/certification/licensing authority.
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