Healthcare Provider Details

I. General information

NPI: 1891957205
Provider Name (Legal Business Name): KRISTA R HEPPE CP
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/26/2008
Last Update Date: 06/26/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1055 9TH AVE STE D
LONGVIEW WA
98632-2661
US

IV. Provider business mailing address

PO BOX 2429 1055 9TH AVE STE D
LONGVIEW WA
98632-8486
US

V. Phone/Fax

Practice location:
  • Phone: 360-575-3316
  • Fax: 360-423-7813
Mailing address:
  • Phone: 360-575-3316
  • Fax: 360-423-7813

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YA0400X
TaxonomyAddiction (Substance Use Disorder) Counselor
License NumberCP60002760
License Number StateWA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: