Healthcare Provider Details

I. General information

NPI: 1023488061
Provider Name (Legal Business Name): NATALIE M HEIDTMANN LPC, MS, CADCI
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 10/02/2015
Last Update Date: 03/03/2024
Certification Date: 03/03/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1345 NW WALL ST STE 201
BEND OR
97703-1967
US

IV. Provider business mailing address

20233 SUNDOWNER LN
BEND OR
97703-1152
US

V. Phone/Fax

Practice location:
  • Phone: 541-248-1577
  • Fax:
Mailing address:
  • Phone: 541-248-1577
  • Fax: 541-639-4361

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code101YA0400X
TaxonomyAddiction (Substance Use Disorder) Counselor
License Number15-05-15
License Number StateOR
# 2
Primary TaxonomyY
Taxonomy Code101YP2500X
TaxonomyProfessional Counselor
License Number
License Number StateNULL
# 3
Primary TaxonomyN
Taxonomy Code101YP2500X
TaxonomyProfessional Counselor
License NumberC5105
License Number StateOR

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: