Healthcare Provider Details

I. General information

NPI: 1730092008
Provider Name (Legal Business Name): JESSICA LYNN HEINTZ CADC-R
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 09/25/2026
Last Update Date: 09/25/2026
Certification Date: 09/25/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

411 NE 19TH AVE
PORTLAND OR
97232-4801
US

IV. Provider business mailing address

28039 S OGLESBY RD
CANBY OR
97013-8592
US

V. Phone/Fax

Practice location:
  • Phone: 503-545-8257
  • Fax:
Mailing address:
  • Phone: 971-218-0156
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YA0400X
TaxonomyAddiction (Substance Use Disorder) Counselor
License NumberT-26-6746
License Number StateOR

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: