Individual
HEIDI M NICEWANDER
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
CADC III/LCSW
Contact information
Practice address
1438 SE DIVISION ST, PORTLAND, OR 97202-1140
(503) 548-0346
(503) 232-5959
Mailing address
211 SE CARUTHERS ST, PORTLAND, OR 97214-4502
(503) 224-1044
(971) 260-0355
Taxonomy
Speciality
Code
Description
License number
State
101YA0400X
Addiction (Substance Use Disorder) Counselor
25-03-30143
OR
1041C0700X
Clinical Social Worker
Primary
L6300
OR
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
2138414
—
WA
05
—
500701727
—
OR
05
—
500815100
—
OR
Enumeration date
11/12/2014
Last updated
03/11/2025
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