Data from the NPPES registry. May not reflect recent changes — verify at nppes.cms.hhs.gov.
HEIDI KATHLEEN HICINBOTHOM
Active Sole ProprietorHEIDI KATHLEEN HICINBOTHOM is a Peer Specialist healthcare provider located in GRAND RONDE, Oregon. NPI 1023534252 is currently active in the NPPES registry. Verify at CMS.
Peer Specialist · GRAND RONDE, OR
Registration Details
- NPI Number
- 1023534252
- Provider Type
- Individual
- Gender
- Female
- NPI Issued
- Aug 18, 2017 (8.8450566859059 yrs)
- Last Updated
- Dec 2, 2021
- Licenses
-
T-21-874 (OR)THW000001683 (OR)
- Sole Proprietor
- Yes
Practice Information
- Address
-
9605 GRAND RONDE RDGRAND RONDE, OR, 973479712Browse OR providers · Browse ZIP 97347
- Phone
- 5038792026
- Primary Specialty
-
Peer Specialist
175T00000X
- Additional Specialty
- Peer Specialist
- Additional Specialty
- Peer Specialist
Other Peer Specialist Providers in GRAND RONDE, OR
| Name | Credential | NPI |
|---|---|---|
| TRACI DIANE HAMILTON | — | 1679056436 |
| NATASHA RAE WORDEN | PEER SUPPORT | 1063107308 |
| SHELLY RAE FOX | — | 1619664711 |
| CHRISTINA MORGAN | CRM, PSS | 1851174452 |
| MICHAEL HENRY | PWS | 1154104800 |
| JOSEPH SHANE COX | — | 1457157752 |
Data sourced from the NPPES National Provider Identifier registry. This information is for informational purposes only and is not a substitute for verifying credentials with the appropriate licensing authority. For official verification, use the NPPES NPI Registry or the relevant state medical board.