HEIDI KATHLEEN HICINBOTHOM
NPI 1023534252
Peer Specialist in Grand Ronde, OR

Active since August 18, 2017
9605 GRAND RONDE RD, GRAND RONDE, OR 97347(503) 879-2026 Get Directions Write a Review

NPPES record last updated: December 2, 2021. Verified against the NPPES registry weekly; last sync: July 26, 2026.

Record update history: Dec 2, 2021, Aug 18, 2017 (2 updates tracked since 2017).

About Heidi Kathleen Hicinbothom NPPES

Official registry information on file with the National Plan and Provider Enumeration System.

HEIDI KATHLEEN HICINBOTHOM (NPI 1023534252) is an individual peer specialist in Grand Ronde, Oregon, licensed in Oregon (THW000001683) and active in the NPI registry since August 2017.

NPPES Registry Identity

NPI1023534252
Entity TypeIndividualFemale
Primary Taxonomy175T00000X
Provider Legal NameHEIDI KATHLEEN HICINBOTHOM
Location Address9605 GRAND RONDE RDGrand Ronde, OR 97347-9712
Mailing Address9605 Grand Ronde RdGrand Ronde, OR 97347-9712 · (503) 879-2002
Sole ProprietorYes
Enumeration DateAugust 18, 2017
Last NPPES UpdateDecember 2, 20212 updates tracked since enumeration
NPPES CertifiedDecember 2, 2021
NPI 1023534252 is a valid, active identifier and passes the ISO check-digit test.

Specialties & Licenses 2

Primary SpecialtyPeer SpecialistOther Service Providers
Taxonomy Code175T00000X
License Licensed in OR · THW000001683
Definition

Individuals certified to perform peer support services through a training process defined by a government agency, such as the Department of Veterans Affairs or a state mental health department/certification/licensing authority.

Also ListedCounselor · Addiction (Substance Use Disorder)Taxonomy 101YA0400X · License T-21-874 (OR)
9605 GRAND RONDE RD, Grand Ronde, OR 97347

Other Identifiers 1

Medicaid500753908OR

Accepted Insurance

Other Providers at the Same Location NPPES 20

Providers registered at the same practice address, or within the immediate area, according to the NPPES registry.

Community Health Worker
9605 GRAND RONDE RD
GRAND RONDE, OR 97347
Peer Specialist
9605 GRAND RONDE RD
GRAND RONDE, OR 97347
Counselor (Addiction (Substance Use Disorder))
9605 GRAND RONDE RD
GRAND RONDE, OR 97347
Dentist
9605 GRAND RONDE RD
GRAND RONDE, OR 97347
Dentist
9605 GRAND RONDE RD
GRAND RONDE, OR 97347
Nurse Practitioner (Psychiatric/Mental Health)
9605 GRAND RONDE RD
GRAND RONDE, OR 97347
Clinic/Center (Community Health)
9605 GRAND RONDE RD
GRAND RONDE, OR 97347
Peer Specialist
9605 GRAND RONDE RD
GRAND RONDE, OR 97347

Frequently Asked Questions NPPES & CMS

Common questions about this NPI record, answered from the official NPPES registry and CMS datasets shown on this page.

What is Heidi Hicinbothom's NPI number?

The NPI number for Heidi Hicinbothom is 1023534252. It was assigned to this individual provider in the NPPES registry on August 18, 2017.

Where is Heidi Hicinbothom located?

Heidi Hicinbothom practices at 9605 Grand Ronde Rd, Grand Ronde, OR 97347. The listed phone number is (503) 879-2026.

What is Heidi Hicinbothom's specialty?

The primary specialty registered for this NPI is Peer Specialist with taxonomy code 175T00000X.

What insurance does Heidi Hicinbothom accept?

Health plans from Moda Health Plan, Inc. list Heidi Hicinbothom as in-network in at least one marketplace plan. Coverage varies by plan and year; verify with the insurer or the provider before a visit.

When was this NPI record last updated?

The NPPES record for Heidi Hicinbothom was last updated on December 2, 2021. NPI Profile syncs with the weekly NPPES data releases published by CMS.