Individual provider · Type 1 NPI

Heidi Kathleen Hicinbothom

Peer Specialist · Grand Ronde, OR

NPI number 1023534252 Active

Practice location

9605 Grand Ronde Rd
Grand Ronde, OR 97347-9712

Call (503) 879-2026 Map

Specialties and licenses

TaxonomyCodeLicense
Addiction (Substance Use Disorder) Counselor 101YA0400XT-21-874 (OR)
Peer Specialist 175T00000XNone listed
Peer Specialist Primary 175T00000XTHW000001683 (OR)

Peer Specialist: Individuals certified to perform peer support services through a training process defined by a government agency, such as the Department of Veterans Affairs or a state mental health department/certification/licensing authority.

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About NPI 1023534252

Heidi Kathleen Hicinbothom's National Provider Identifier is 1023534252, issued on Aug 18, 2017. The primary taxonomy on file is Peer Specialist (175T00000X), and the practice location is in Grand Ronde, OR. The record was last updated on Dec 2, 2021.