Healthcare Provider Details

I. General information

NPI: 1003106790
Provider Name (Legal Business Name): LINDA HEINS, LCSW, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 04/14/2011
Last Update Date: 04/14/2011
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

10001 SE SUNNYSIDE RD STE 140
CLACKAMAS OR
97015-9804
US

IV. Provider business mailing address

10001 SE SUNNYSIDE RD STE 140
CLACKAMAS OR
97015-9804
US

V. Phone/Fax

Practice location:
  • Phone: 503-653-5205
  • Fax: 503-653-5219
Mailing address:
  • Phone: 503-653-5205
  • Fax: 503-653-5219

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License NumberL1800
License Number StateOR

VII. Legacy identifiers

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

VIII. Authorized Official

Name: LINDA HEINS
Title or Position: LCSW
Credential: LCSW
Phone: 503-653-5205