Provider Demographics
NPI:1023488061
Name:HEIDTMANN, NATALIE M (LPC, MS, CADCI)
Entity type:Individual
Prefix:
First Name:NATALIE
Middle Name:M
Last Name:HEIDTMANN
Suffix:
Gender:F
Credentials:LPC, MS, CADCI
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:20233 SUNDOWNER LN
Mailing Address - Street 2:
Mailing Address - City:BEND
Mailing Address - State:OR
Mailing Address - Zip Code:97703-1152
Mailing Address - Country:US
Mailing Address - Phone:541-248-1577
Mailing Address - Fax:541-639-4361
Practice Address - Street 1:1345 NW WALL ST STE 201
Practice Address - Street 2:
Practice Address - City:BEND
Practice Address - State:OR
Practice Address - Zip Code:97703-1967
Practice Address - Country:US
Practice Address - Phone:541-248-1577
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2015-10-02
Last Update Date:2024-03-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
101YP2500X
OR15-05-15101YA0400X
ORC5105101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessionalGroup - Single Specialty
No101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)Group - Single Specialty