Provider Demographics
NPI:1801004353
Name:HEDRICK, LEIGH AUSTIN (MD)
Entity Type:Individual
Prefix:
First Name:LEIGH
Middle Name:AUSTIN
Last Name:HEDRICK
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:619 SW 6TH AVE.
Mailing Address - Street 2:5TH FL
Mailing Address - City:PORTLAND
Mailing Address - State:OR
Mailing Address - Zip Code:97209-8970
Mailing Address - Country:US
Mailing Address - Phone:503-988-7468
Mailing Address - Fax:
Practice Address - Street 1:619 SW 6TH AVE.
Practice Address - Street 2:5TH FL
Practice Address - City:PORTLAND
Practice Address - State:OR
Practice Address - Zip Code:97209-8970
Practice Address - Country:US
Practice Address - Phone:503-988-7468
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-05-18
Last Update Date:2022-02-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ORMD273112084P0800X, 390200000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2084P0800XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyPsychiatry
No390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program
Provider Identifiers
StateIdentifier IDID TypeIssuer
OR022959Medicaid