Healthcare Provider Details

I. General information

NPI: 1184299778
Provider Name (Legal Business Name): MRS. HEATHER M WADDLE
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/25/2021
Last Update Date: 12/04/2025
Certification Date: 12/04/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

130 YELLOWSTONE DR STE 100
CHICO CA
95973-5884
US

IV. Provider business mailing address

6 MIONE WAY
CHICO CA
95926-1503
US

V. Phone/Fax

Practice location:
  • Phone: 530-879-5991
  • Fax:
Mailing address:
  • Phone: 530-356-3731
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code106H00000X
TaxonomyMarriage & Family Therapist
License Number159217
License Number StateCA
# 2
Primary TaxonomyN
Taxonomy Code101YA0400X
TaxonomyAddiction (Substance Use Disorder) Counselor
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: