MEDICARE: DR. HEATHER A GAEDT PSY.D.

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	103TC0700X	Clinical Psychologist	PSY 25313	CA

General Provider Information

NPI Number	:	1417292657
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. HEATHER A GAEDT PSY.D.

Provider Business Mailing Address
First Line	:	PO BOX 2542
Second Line	:
City	:	PALM DESERT
State	:	CA
Zip	:	92261-2542
Country	:	US
Telephone Number	:	760-834-1586
Fax Number	:

Provider Business Practice Location Address
First Line	:	74040 HIGHWAY 111 STE J4
Second Line	:
City	:	PALM DESERT
State	:	CA
Zip	:	92260-4159
Country	:	US
Telephone Number	:	760-834-1586
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	11/28/2012
Last Update Date	:	05/26/2014

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