Provider Demographics
NPI:1861977183
Name:HOSTETLER, CHRISTINA L
Entity type:Individual
Prefix:
First Name:CHRISTINA
Middle Name:L
Last Name:HOSTETLER
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:CHRISTINA
Other - Middle Name:L
Other - Last Name:RANDALL
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:2350 SE TERRITORIAL RD
Mailing Address - Street 2:
Mailing Address - City:CANBY
Mailing Address - State:OR
Mailing Address - Zip Code:97013-9732
Mailing Address - Country:US
Mailing Address - Phone:206-214-6445
Mailing Address - Fax:503-266-7659
Practice Address - Street 1:2350 SE TERRITORIAL RD
Practice Address - Street 2:
Practice Address - City:CANBY
Practice Address - State:OR
Practice Address - Zip Code:97013-9732
Practice Address - Country:US
Practice Address - Phone:206-214-6445
Practice Address - Fax:503-266-7659
Is Sole Proprietor?:No
Enumeration Date:2018-10-02
Last Update Date:2020-07-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ORC4400101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional