=====================================================
General NPI Number Information
=====================================================
NPI Number | 1700188935
-----------------------------------------------------
Entity Type | Individual
-----------------------------------------------------
Provider Name | HEATHER L PHILLIPS LSCW
-----------------------------------------------------
Gender | Female
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 11/19/2010
-----------------------------------------------------
Last Update Date | 04/08/2019
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 7431 NE EVERGREEN PKWY STE 100
-----------------------------------------------------
City | HILLSBORO
-----------------------------------------------------
State | OR
-----------------------------------------------------
Zip | 97124-5831
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 503-840-3400
-----------------------------------------------------
Fax | 503-840-3409
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 7650 SW BEVELAND RD STE 200
-----------------------------------------------------
City | PORTLAND
-----------------------------------------------------
State | OR
-----------------------------------------------------
Zip | 97223-8692
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 503-601-3615
-----------------------------------------------------
Fax | 503-646-1683
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position |
-----------------------------------------------------
Name |
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone |
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 1041C0700X
-----------------------------------------------------
Taxonomy Name | Clinical Social Worker
-----------------------------------------------------
License Number | LW60248697
-----------------------------------------------------
License Number State | WA
-----------------------------------------------------
Taxonomy #2
-----------------------------------------------------
Taxonomy Code | 1041C0700X
-----------------------------------------------------
Taxonomy Name | Clinical Social Worker
-----------------------------------------------------
License Number | L7933
-----------------------------------------------------
License Number State | OR
-----------------------------------------------------