HEIDI HICINBOTHOM

Peer Specialist

Active Individual
NPI: 1023534252

Practice Address

9605 GRAND RONDE RD
Grand Ronde, OR 97347

Phone: (503) 879-2026

Specialties

Specialty Code Primary License
Counselor - Addiction (Substance Use Disorder) 101YA0400X No T-21-874 (OR)
Peer Specialist 175T00000X Yes THW000001683 (OR)

Frequently Asked Questions

NPI 1023534252 is the National Provider Identifier for HEIDI HICINBOTHOM, a Peer Specialist provider located in Grand Ronde, OR. This NPI was enumerated on August 18, 2017.
HEIDI HICINBOTHOM practices at 9605 GRAND RONDE RD, Grand Ronde, OR 97347.

Quick Facts

NPI
1023534252
Type
Individual
Enumerated
Aug 18, 2017
Last Updated
Dec 2, 2021

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