Healthcare Provider Details

I. General information

NPI: 1356060156
Provider Name (Legal Business Name): HEATHER WHITNEE FIFE
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/24/2022
Last Update Date: 01/09/2025
Certification Date: 01/09/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

435 NE EVANS ST
MCMINNVILLE OR
97128-4628
US

IV. Provider business mailing address

1094 46TH PL SE
SALEM OR
97317-6001
US

V. Phone/Fax

Practice location:
  • Phone: 209-985-4509
  • Fax:
Mailing address:
  • Phone: 209-985-4509
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code171M00000X
TaxonomyCase Manager/Care Coordinator
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code175T00000X
TaxonomyPeer Specialist
License Number105975
License Number StateOR
# 3
Primary TaxonomyY
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: