MEDICARE: HEATHER CARISSA HANNIGAN LE

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	174400000X	Specialist	BAP-E-10243881	OR

General Provider Information

NPI Number	:	1396581625
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	HEATHER CARISSA HANNIGAN LE

Provider Business Mailing Address
First Line	:	80 SE MADISON ST STE 140
Second Line	:
City	:	PORTLAND
State	:	OR
Zip	:	97214-4527
Country	:	US
Telephone Number	:	503-593-1933
Fax Number	:

Provider Business Practice Location Address
First Line	:	80 SE MADISON ST STE 140
Second Line	:
City	:	PORTLAND
State	:	OR
Zip	:	97214-4527
Country	:	US
Telephone Number	:	503-593-1933
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	07/05/2024
Last Update Date	:	03/04/2026

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Directions to “ HEATHER CARISSA HANNIGAN LE” Practice Location

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