Heidi Kathleen Hicinbothom, is a
Peer Specialist based in Grand Ronde, Oregon. Heidi Kathleen Hicinbothom is licensed to practice in Oregon (license number THW000001683) and her current practice location is
9605 Grand Ronde Rd, Grand Ronde, Oregon. She can be reached at her office (for appointments etc.) via phone at
(503) 879-2026.
NPI number for Heidi Kathleen Hicinbothom is 1023534252 and her current mailing address is 9605 Grand Ronde Rd, Grand Ronde, Oregon. She
does not participate in medicare program and thus does not accept medicare assignments. Her NPI Number is 1023534252.
Healthcare Provider's Profile
| Full Name | Heidi Kathleen Hicinbothom |
|---|
| Gender | Female |
|---|
| Speciality | Peer Specialist |
|---|
| Location | 9605 Grand Ronde Rd, Grand Ronde, Oregon |
|---|
| Accepts Medicare Assignments | Does not participate in Medicare Program. She may not accept medicare assignment. |
|---|
NPI Data:
- NPI Number: 1023534252
- Provider Enumeration Date: 08/18/2017
- Last Update Date: 12/02/2021
Medical Identifiers
Medical identifiers for Heidi Kathleen Hicinbothom such as npi, medicare ID, medicare PIN, medicaid, etc.
| Identifier | Type | State | Issuer |
|---|
| 1023534252 | NPI | - | NPPES |
| 500753908 | Medicaid | OR | |
Medical Taxonomies and Licenses
| Taxonomy | Type | License (State) | Status |
|---|
| 101YA0400X | Counselor - Addiction (substance Use Disorder) | T-21-874 (Oregon) | Secondary |
| 175T00000X | Peer Specialist | (* (Not Available)) | Secondary |
| 175T00000X | Peer Specialist | THW000001683 (Oregon) | Primary |
Medicare Part D Prescriber Enrollment
Any physician or other eligible professional who prescribes Part D drugs must either enroll in the Medicare program or opt out in order to prescribe drugs to their patients with Part D prescription drug benefit plans. Heidi Kathleen Hicinbothom is
NOT enrolled with medicare and thus cannot prescribe medicare part D drugs to patients with medicare part D benefits.
Mailing Address and Practice Location
| Mailing Address | Practice Location Address |
|---|
Heidi Kathleen Hicinbothom,
9605 Grand Ronde Rd,
Grand Ronde, OR 97347-9712
Ph: (503) 879-2002 | Heidi Kathleen Hicinbothom,
9605 Grand Ronde Rd,
Grand Ronde, OR 97347-9712
Ph: (503) 879-2026 |
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