Provider Demographics
NPI:1275689739
Name:HEINSON, DAVID ROBERT (QMHA)
Entity Type:Individual
Prefix:
First Name:DAVID
Middle Name:ROBERT
Last Name:HEINSON
Suffix:
Gender:M
Credentials:QMHA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 33351
Mailing Address - Street 2:
Mailing Address - City:PORTLAND
Mailing Address - State:OR
Mailing Address - Zip Code:97292-3351
Mailing Address - Country:US
Mailing Address - Phone:503-880-9444
Mailing Address - Fax:
Practice Address - Street 1:13317 SE POWELL BLVD
Practice Address - Street 2:
Practice Address - City:PORTLAND
Practice Address - State:OR
Practice Address - Zip Code:97236-3335
Practice Address - Country:US
Practice Address - Phone:503-760-9606
Practice Address - Fax:503-760-9609
Is Sole Proprietor?:Yes
Enumeration Date:2007-01-26
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171M00000XOther Service ProvidersCase Manager/Care Coordinator