Provider Demographics
NPI:1417917246
Name:JOLSON, HEIDI (MA LPC NCC CADC I)
Entity Type:Individual
Prefix:MS
First Name:HEIDI
Middle Name:
Last Name:JOLSON
Suffix:
Gender:F
Credentials:MA LPC NCC CADC I
Other - Prefix:
Other - First Name:HEIDI
Other - Middle Name:N
Other - Last Name:JACOBSON
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:MA CADC I
Mailing Address - Street 1:4300 NE FREMONT ST STE 260
Mailing Address - Street 2:
Mailing Address - City:PORTLAND
Mailing Address - State:OR
Mailing Address - Zip Code:97213-1100
Mailing Address - Country:US
Mailing Address - Phone:503-709-0456
Mailing Address - Fax:503-334-1529
Practice Address - Street 1:4300 NE FREMONT ST STE 260
Practice Address - Street 2:
Practice Address - City:PORTLAND
Practice Address - State:OR
Practice Address - Zip Code:97213-1100
Practice Address - Country:US
Practice Address - Phone:503-709-0456
Practice Address - Fax:503-334-1529
Is Sole Proprietor?:Yes
Enumeration Date:2006-03-24
Last Update Date:2022-05-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OR990318101YA0400X
ORC1694101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional
No101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)