Healthcare Provider Details

I. General information

NPI: 1598016016
Provider Name (Legal Business Name): ELIZABETH HEGLIN
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 09/24/2012
Last Update Date: 09/24/2012
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

801 7TH ST
DAVENPORT WA
99122-8676
US

IV. Provider business mailing address

PO BOX 2186
DEER PARK WA
99006-2186
US

V. Phone/Fax

Practice location:
  • Phone: 509-725-1481
  • Fax:
Mailing address:
  • Phone: 509-294-9374
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code103TS0200X
TaxonomySchool Psychologist
License Number491464D
License Number StateWA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: