Provider Demographics
NPI:1568149706
Name:HILLSTROM, ANGELA (CADC REGISTRANT)
Entity Type:Individual
Prefix:
First Name:ANGELA
Middle Name:
Last Name:HILLSTROM
Suffix:
Gender:F
Credentials:CADC REGISTRANT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1052 SW 4TH AVE STE 2
Mailing Address - Street 2:
Mailing Address - City:ONTARIO
Mailing Address - State:OR
Mailing Address - Zip Code:97914-2100
Mailing Address - Country:US
Mailing Address - Phone:541-216-6068
Mailing Address - Fax:541-216-6094
Practice Address - Street 1:1052 SW 4TH AVE STE 2
Practice Address - Street 2:
Practice Address - City:ONTARIO
Practice Address - State:OR
Practice Address - Zip Code:97914-2100
Practice Address - Country:US
Practice Address - Phone:541-216-6068
Practice Address - Fax:541-216-6094
Is Sole Proprietor?:No
Enumeration Date:2023-06-29
Last Update Date:2023-06-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OR101YA0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)
Provider Identifiers
StateIdentifier IDID TypeIssuer
OR500792489Medicaid