Provider Demographics
NPI:1164959011
Name:BOTHUM-HASLEBACHER, CINDY D
Entity Type:Individual
Prefix:
First Name:CINDY
Middle Name:D
Last Name:BOTHUM-HASLEBACHER
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:8855 SW HOLLY LN STE 122
Mailing Address - Street 2:
Mailing Address - City:WILSONVILLE
Mailing Address - State:OR
Mailing Address - Zip Code:97070-8793
Mailing Address - Country:US
Mailing Address - Phone:503-682-7744
Mailing Address - Fax:503-682-3384
Practice Address - Street 1:8855 SW HOLLY LN STE 122
Practice Address - Street 2:
Practice Address - City:WILSONVILLE
Practice Address - State:OR
Practice Address - Zip Code:97070-8793
Practice Address - Country:US
Practice Address - Phone:503-682-7744
Practice Address - Fax:503-682-3384
Is Sole Proprietor?:Yes
Enumeration Date:2017-05-22
Last Update Date:2022-07-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)