Healthcare Provider Details

I. General information

NPI: 1770428781
Provider Name (Legal Business Name): LYLAH HEIDER SOCM
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 04/23/2026
Last Update Date: 04/23/2026
Certification Date: 04/23/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

7533 WOODS LAKE RD
MONROE WA
98272-7808
US

IV. Provider business mailing address

7533 WOODS LAKE RD
MONROE WA
98272-7808
US

V. Phone/Fax

Practice location:
  • Phone: 425-551-0991
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code171000000X
TaxonomyMilitary Health Care Provider
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: