Individual
RANDY HEATER
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Contact information
Practice address
10763 SW GREENBURG RD STE 100, TIGARD, OR 97223-5492
(503) 684-8159
(503) 598-0934
Mailing address
10763 SW GREENBURG RD STE 100, TIGARD, OR 97223-5492
(503) 684-8159
(503) 598-0934
Taxonomy
Speciality
Code
Description
License number
State
101YA0400X
Addiction (Substance Use Disorder) Counselor
Primary
15-P-04
OR
Other
Enumeration date
04/01/2016
Last updated
04/11/2018
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