Individual
HEIDI KATHLEEN HICINBOTHOM
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Contact information
Practice address
9605 GRAND RONDE RD, GRAND RONDE, OR 97347-9712
(503) 879-2026
Mailing address
9605 GRAND RONDE RD, GRAND RONDE, OR 97347-9712
(503) 879-2002
Taxonomy
Speciality
Code
Description
License number
State
101YA0400X
Addiction (Substance Use Disorder) Counselor
T-21-874
OR
175T00000X
Peer Specialist
Primary
THW000001683
OR
175T00000X
Peer Specialist
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
500753908
—
OR
Enumeration date
08/18/2017
Last updated
12/02/2021
About Stedi
Stedi is the only programmable healthcare clearinghouse. You can use Stedi's APIs to process eligibility checks, claims, remits, and more.
Contact us