Healthcare Provider Details

I. General information

NPI: 1417109968
Provider Name (Legal Business Name): RICHARD MARTIN HEDLUND MA
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 10/15/2008
Last Update Date: 10/15/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

10 PIER 1 206
ASTORIA OR
97103-6300
US

IV. Provider business mailing address

10 PIER 1 206
ASTORIA OR
97103-6300
US

V. Phone/Fax

Practice location:
  • Phone: 503-338-9423
  • Fax: 866-625-3941
Mailing address:
  • Phone: 503-338-9423
  • Fax: 866-625-3941

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YP2500X
TaxonomyProfessional Counselor
License NumberC2244
License Number StateOR

VII. Legacy identifiers

For crosswalk purposes, the following legacy (non-NPI) identifiers are available for this provider:

# 1
IdentifierC2244
Identifier TypeOTHER
Identifier StateOR
Identifier IssuerPROFESSIONAL COUNSELOR LICENSE

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: