Provider Demographics
NPI:1578235503
Name:HEIGES, ALICIA RENEE (LMT)
Entity Type:Individual
Prefix:
First Name:ALICIA
Middle Name:RENEE
Last Name:HEIGES
Suffix:
Gender:F
Credentials:LMT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 1271
Mailing Address - Street 2:
Mailing Address - City:SCAPPOOSE
Mailing Address - State:OR
Mailing Address - Zip Code:97056-1271
Mailing Address - Country:US
Mailing Address - Phone:971-718-8400
Mailing Address - Fax:
Practice Address - Street 1:51577 COLUMBIA RIVER HWY
Practice Address - Street 2:SUITE D, ROOM 1
Practice Address - City:SCAPPOOSE
Practice Address - State:OR
Practice Address - Zip Code:97056
Practice Address - Country:US
Practice Address - Phone:503-987-4265
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2021-09-28
Last Update Date:2023-08-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OR10922225700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage Therapist