Provider Demographics
NPI:1861848863
Name:HANNAH HOEFLICH LLC
Entity Type:Organization
Organization Name:HANNAH HOEFLICH LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CLINICAL PSYCHOLOGIST
Authorized Official - Prefix:DR
Authorized Official - First Name:HANNAH
Authorized Official - Middle Name:
Authorized Official - Last Name:HOEFLICH
Authorized Official - Suffix:
Authorized Official - Credentials:PSYD
Authorized Official - Phone:503-928-2900
Mailing Address - Street 1:7415 N OATMAN AVE
Mailing Address - Street 2:
Mailing Address - City:PORTLAND
Mailing Address - State:OR
Mailing Address - Zip Code:97217-1213
Mailing Address - Country:US
Mailing Address - Phone:503-928-2900
Mailing Address - Fax:
Practice Address - Street 1:7415 N OATMAN AVE
Practice Address - Street 2:
Practice Address - City:PORTLAND
Practice Address - State:OR
Practice Address - Zip Code:97217-1213
Practice Address - Country:US
Practice Address - Phone:503-928-2900
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2016-05-09
Last Update Date:2016-05-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OR2643261QM0801X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QM0801XAmbulatory Health Care FacilitiesClinic/CenterMental Health (Including Community Mental Health Center)