Provider Demographics
NPI:1356004287
Name:SIMPSON, HEATHER LEILANI (MA)
Entity Type:Individual
Prefix:
First Name:HEATHER
Middle Name:LEILANI
Last Name:SIMPSON
Suffix:
Gender:F
Credentials:MA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:107 SE WASHINGTON ST STE 470
Mailing Address - Street 2:
Mailing Address - City:PORTLAND
Mailing Address - State:OR
Mailing Address - Zip Code:97214-2198
Mailing Address - Country:US
Mailing Address - Phone:971-599-1843
Mailing Address - Fax:
Practice Address - Street 1:107 SE WASHINGTON ST STE 470
Practice Address - Street 2:
Practice Address - City:PORTLAND
Practice Address - State:OR
Practice Address - Zip Code:97214-2198
Practice Address - Country:US
Practice Address - Phone:971-599-1843
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2021-10-18
Last Update Date:2021-10-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OR106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist