Individual
HEATHER CARISSA HANNIGAN
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
LE
Contact information
Practice address
80 SE MADISON ST STE 140, PORTLAND, OR 97214-4527
(503) 593-1933
Mailing address
80 SE MADISON ST STE 140, PORTLAND, OR 97214-4527
(503) 593-1933
Taxonomy
Speciality
Code
Description
License number
State
174400000X
Specialist
Primary
BAP-E-10243881
OR
Other
Enumeration date
07/05/2024
Last updated
03/04/2026
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