Provider Demographics
NPI:1619453057
Name:CORTEZ-HICKOX, LYDIA (CRM II, QMHA)
Entity Type:Individual
Prefix:
First Name:LYDIA
Middle Name:
Last Name:CORTEZ-HICKOX
Suffix:
Gender:F
Credentials:CRM II, QMHA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1027 E BURNSIDE ST
Mailing Address - Street 2:
Mailing Address - City:PORTLAND
Mailing Address - State:OR
Mailing Address - Zip Code:97214-1328
Mailing Address - Country:US
Mailing Address - Phone:503-239-8400
Mailing Address - Fax:503-239-8406
Practice Address - Street 1:720 SE WASHINGTON ST
Practice Address - Street 2:
Practice Address - City:HILLSBORO
Practice Address - State:OR
Practice Address - Zip Code:97123-4230
Practice Address - Country:US
Practice Address - Phone:503-648-0753
Practice Address - Fax:503-648-0755
Is Sole Proprietor?:No
Enumeration Date:2018-07-18
Last Update Date:2023-09-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes175T00000XOther Service ProvidersPeer Specialist