Hicinbothom, Heidi Kathleen

Hicinbothom, Heidi Kathleen is an sole proprietor health care provider with primary practice located at 9605 Grand Ronde Rd , Grand Ronde OR 97347-9712. She recently has 2 registered licenses in different health care specialties including Behavioral Health & Social Service Providers / Addiction (Substance Use Disorder), Other Service Providers / Peer Specialist. Other Service Providers / Peer Specialist is her primary health care specialty. Hicinbothom, Heidi Kathleen can be contacted via phone (503) 879-2026.

Contact Information

Primary practice address
9605 Grand Ronde Rd Grand Ronde OR 97347-9712
Phone: (503) 879-2026
Fax:
Website:
Map and Directions

Health care specialties

SpecialtyCodeLicense #State
Behavioral Health & Social Service Providers / Addiction (Substance Use Disorder) 101YA0400X T-21-874 Oregon
Other Service Providers / Peer Specialist 175T00000X
Other Service Providers / Peer Specialist 175T00000X THW000001683 Oregon

Profile Details

NPI number 1023534252
LBN Legal business name Hicinbothom, Heidi Kathleen
Credentials
Entity Individual
Sole proprietor 1 Yes
Enumeration date Aug 18th, 2017
Last updated Dec 2nd, 2021 - about 5 years ago

1 A sole proprietor/sole proprietorship is an individual, and in that capacity, is qualified for a solitary NPI number. The sole proprietor have to apply for the NPI number using his or her own particular Social Security Number (SSN), instead of Employer Identification Number (EIN) regardless of whether he/she has an EIN.

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Identifiers

StateTypeNumberIssuer
All States NPI 1023534252 NPPES
Oregon MEDICAID 500753908

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