Provider Demographics
NPI:1699408914
Name:HATHAWAY, LINDSEY DEANN (CADCI-R, CRM)
Entity Type:Individual
Prefix:MRS
First Name:LINDSEY
Middle Name:DEANN
Last Name:HATHAWAY
Suffix:
Gender:F
Credentials:CADCI-R, CRM
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1815 SW 17TH ST
Mailing Address - Street 2:
Mailing Address - City:REDMOND
Mailing Address - State:OR
Mailing Address - Zip Code:97756-3213
Mailing Address - Country:US
Mailing Address - Phone:541-801-0793
Mailing Address - Fax:
Practice Address - Street 1:1655 SW HIGHLAND AVE STE 3
Practice Address - Street 2:
Practice Address - City:REDMOND
Practice Address - State:OR
Practice Address - Zip Code:97756-2558
Practice Address - Country:US
Practice Address - Phone:541-923-2654
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2022-07-05
Last Update Date:2023-09-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OR22-CRM-1123175T00000X
ORT-23-2267101YA0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)
No175T00000XOther Service ProvidersPeer Specialist