Healthcare Provider Details

I. General information

NPI: 1811130735
Provider Name (Legal Business Name): HEIDI DYLANI MONTOYA PEREZ PHD
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

Provider Other Name: HEIDI DYLANI MONTOYA PHD

II. Dates (important events)

Enumeration Date: 04/07/2009
Last Update Date: 07/12/2019
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1959 NE PACIFIC ST
SEATTLE WA
98195-4410
US

IV. Provider business mailing address

PO BOX 50095
SEATTLE WA
98145-5095
US

V. Phone/Fax

Practice location:
  • Phone: 206-520-5000
  • Fax:
Mailing address:
  • Phone: 206-520-5700
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code103TC0700X
TaxonomyClinical Psychologist
License Number60336314
License Number StateWA
# 2
Primary TaxonomyY
Taxonomy Code103TR0400X
TaxonomyRehabilitation Psychologist
License NumberPY60336314
License Number StateWA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: