Healthcare Provider Details

I. General information

NPI: 1740344175
Provider Name (Legal Business Name): EMILY R HEDGES MA, LPC, CADCIII
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 12/20/2006
Last Update Date: 11/04/2009
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

9670 SW BEAVERTON HILLSDALE HWY
BEAVERTON OR
97005-3307
US

IV. Provider business mailing address

PO BOX 82819
PORTLAND OR
97282-0819
US

V. Phone/Fax

Practice location:
  • Phone: 503-626-9494
  • Fax: 503-646-5671
Mailing address:
  • Phone: 503-233-5405
  • Fax: 503-233-2696

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YA0400X
TaxonomyAddiction (Substance Use Disorder) Counselor
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code101YP2500X
TaxonomyProfessional Counselor
License NumberC2199
License Number StateOR

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: