Provider Demographics
NPI:1417109968
Name:HEDLUND, RICHARD MARTIN (MA)
Entity Type:Individual
Prefix:MR
First Name:RICHARD
Middle Name:MARTIN
Last Name:HEDLUND
Suffix:
Gender:M
Credentials:MA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:10 PIER 1
Mailing Address - Street 2:206
Mailing Address - City:ASTORIA
Mailing Address - State:OR
Mailing Address - Zip Code:97103-6300
Mailing Address - Country:US
Mailing Address - Phone:503-338-9423
Mailing Address - Fax:866-625-3941
Practice Address - Street 1:10 PIER 1
Practice Address - Street 2:206
Practice Address - City:ASTORIA
Practice Address - State:OR
Practice Address - Zip Code:97103-6300
Practice Address - Country:US
Practice Address - Phone:503-338-9423
Practice Address - Fax:866-625-3941
Is Sole Proprietor?:No
Enumeration Date:2008-10-15
Last Update Date:2008-10-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ORC2244101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional
Provider Identifiers
StateIdentifier IDID TypeIssuer
ORC2244OtherPROFESSIONAL COUNSELOR LICENSE