Active NPI
Hallie Havican, LCSW
- Clinical Social Worker
- Portland, OR
National Provider Identifier
1124459771
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Clinical Social Worker
- License
- ASW-68709
- Practice address
- 1110 SE Alder St # 310
Portland, OR 97214-2400 - Phone
- (503) 847-9950
- NPI assigned
- Dec 9, 2013
- Sex
- Female
- Sole proprietor
- Yes
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 1
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Clinical Social Worker | 1041C0700X | ASW-68709 | CA | Primary |
Addresses
Primary practice location
1110 SE Alder St # 310
Portland, OR 97214-2400
Mailing address
PO Box 86953
Portland, OR 97286-0953
Phone (503) 847-9950
Other practice location 1
3870 Rosin Ct Ste 130
Sacramento, CA 95834-1647
Phone (916) 363-1553
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Not enrolled
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| ASW-68709 | CA | MD | Clinical Social Worker |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1386547200000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1564876800000",
"number": "1124459771",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "PO BOX 86953",
"city": "PORTLAND",
"state": "OR",
"postal_code": "972860953",
"telephone_number": "503-847-9950"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "1110 SE ALDER ST # 310",
"city": "PORTLAND",
"state": "OR",
"postal_code": "972142400",
"telephone_number": "503-847-9950"
}
],
"practiceLocations": [
{
"address_1": "3870 Rosin Ct Ste 130",
"address_purpose": "LOCATION",
"city": "Sacramento",
"state": "CA",
"postal_code": "958341647",
"country_code": "US",
"telephone_number": "916-363-1553",
"fax_number": "916-363-1638",
"country_name": "United States",
"address_type": "DOM"
}
],
"basic": {
"last_name": "HAVICAN",
"first_name": "HALLIE",
"name_prefix": "Miss",
"credential": "LCSW",
"sole_proprietor": "YES",
"sex": "F",
"enumeration_date": "2013-12-09",
"last_updated": "2019-08-04",
"status": "A"
},
"taxonomies": [
{
"code": "1041C0700X",
"taxonomy_group": "",
"desc": "Social Worker, Clinical",
"state": "CA",
"license": "ASW-68709",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}
Other providers in Portland, OR
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Aug 4, 2019; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.