Heather Ann Ackles, LCSW

Primary specialty

Mental Health CounselorTaxonomy code 101YM0800X

License

NONE Issued in OR

Practice address

4905 NE 16TH Ave
Portland, OR 97211-5041

Phone

(503) 498-6879

NPI assigned

Oct 25, 2019

Sex

Female

Sole proprietor

Yes

Registry information is reported by the provider to CMS and is not verified. About this source

Specialties & licenses 1

Addresses

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Eligible to order & refer

• Part B services: Yes
• Medical equipment: Yes
• Home health: No
• Power mobility devices: No
• Hospice: No

Green means eligible to order or refer.

Opted out of Medicare

Yes, effective Jan 22, 2024 through Jan 22, 2028

Medicare enrollment (NPD)

Enrolled

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1571961600000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1658966400000",
    "number": "1609419357",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "4905 NE 16TH AVE",
            "city": "PORTLAND",
            "state": "OR",
            "postal_code": "972115041",
            "telephone_number": "503-473-9482"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "4905 NE 16TH AVE",
            "city": "PORTLAND",
            "state": "OR",
            "postal_code": "972115041",
            "telephone_number": "503-498-6879"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "33 NW Broadway",
            "address_purpose": "LOCATION",
            "city": "Portland",
            "state": "OR",
            "postal_code": "972093580",
            "country_code": "US",
            "telephone_number": "503-228-7419",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "last_name": "ACKLES",
        "first_name": "HEATHER",
        "middle_name": "ANN",
        "credential": "LCSW",
        "sole_proprietor": "YES",
        "sex": "F",
        "enumeration_date": "2019-10-25",
        "last_updated": "2022-07-28",
        "certification_date": "2022-07-28",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "101YM0800X",
            "taxonomy_group": "",
            "desc": "Counselor, Mental Health",
            "state": "OR",
            "license": "NONE",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Greg Ackerman
• Josephine May Ackerman, ATC, LAT
• Renata A Ackermann, PHD
• Ruby Alexandra Ackermann, CHW
• Bradley Ackerson, MD
• Melissa Dawn Ackley, MA ART THERAPY
• Blake Vance Acohido, M.D.
• Evelyn Reese Acopan, MA
• Kimberly D Acord
• Acorn Chiropractic LLC

• All providers in Portland, OR
• Mental Health Counselor in Oregon

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 28, 2022; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments; Order and Referring; Opt Out Affidavits.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.