Provider Demographics
NPI:1720631435
Name:HARTSHORN, ISABEL M (CADC I/CRM II/QMHA-I)
Entity type:Individual
Prefix:
First Name:ISABEL
Middle Name:M
Last Name:HARTSHORN
Suffix:
Gender:F
Credentials:CADC I/CRM II/QMHA-I
Other - Prefix:
Other - First Name:IZZY
Other - Middle Name:
Other - Last Name:HARTSHORN
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:CADC I/CRM II/QMHA-I
Mailing Address - Street 1:211 SE CARUTHERS ST
Mailing Address - Street 2:
Mailing Address - City:PORTLAND
Mailing Address - State:OR
Mailing Address - Zip Code:97214-4502
Mailing Address - Country:US
Mailing Address - Phone:503-224-1044
Mailing Address - Fax:971-260-0355
Practice Address - Street 1:12360 E BURNSIDE ST
Practice Address - Street 2:
Practice Address - City:PORTLAND
Practice Address - State:OR
Practice Address - Zip Code:97233-1042
Practice Address - Country:US
Practice Address - Phone:971-279-4800
Practice Address - Fax:971-279-2051
Is Sole Proprietor?:No
Enumeration Date:2019-07-22
Last Update Date:2025-06-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OR22-CRM-II-0056101YA0400X
OR24-QMHA-I-004481101YM0800X
OR23-01-10615101YA0400X, 101YA0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)
No101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
OR500766221Medicaid
OR500812344Medicaid
OR500843415Medicaid