Healthcare Provider Details

I. General information

NPI: 1154243061
Provider Name (Legal Business Name): MATTHEW HEIMGARTNER
Entity Type: Individual
Gender: Male
Sole Proprietor: N

Provider Other Name: MATTY HEIMGARTNER

II. Dates (important events)

Enumeration Date: 07/30/2026
Last Update Date: 07/30/2026
Certification Date: 07/29/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

14935 SE 82ND DR
CLACKAMAS OR
97015-9624
US

IV. Provider business mailing address

4249 SE 9TH AVE APT B
PORTLAND OR
97202-5058
US

V. Phone/Fax

Practice location:
  • Phone: 503-343-8657
  • Fax:
Mailing address:
  • Phone: 408-687-5181
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YA0400X
TaxonomyAddiction (Substance Use Disorder) Counselor
License Number
License Number StateOR

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: