Provider Demographics
NPI:1447587167
Name:MEDINA HEINS, ERIN
Entity Type:Individual
Prefix:
First Name:ERIN
Middle Name:
Last Name:MEDINA HEINS
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:ERIN
Other - Middle Name:
Other - Last Name:MEDINA
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:2051 KAEN RD
Mailing Address - Street 2:1ST FLOOR
Mailing Address - City:OREGON CITY
Mailing Address - State:OR
Mailing Address - Zip Code:97045-4035
Mailing Address - Country:US
Mailing Address - Phone:503-655-8558
Mailing Address - Fax:503-655-8197
Practice Address - Street 1:2051 KAEN RD
Practice Address - Street 2:1ST FLOOR
Practice Address - City:OREGON CITY
Practice Address - State:OR
Practice Address - Zip Code:97045-4035
Practice Address - Country:US
Practice Address - Phone:503-655-8558
Practice Address - Fax:503-655-8197
Is Sole Proprietor?:No
Enumeration Date:2009-11-17
Last Update Date:2009-11-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OR05-11-47101YA0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)