Healthcare Provider Details

I. General information

NPI: 1215900535
Provider Name (Legal Business Name): HEIDI ANN THIESE MS, CGC
Entity Type: Individual
Gender: Female
Sole Proprietor: X

II. Dates (important events)

Enumeration Date: 02/08/2006
Last Update Date: 07/25/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

201 15TH AVE CMB-5
SEATTLE WA
98122-5603
US

IV. Provider business mailing address

8409 40TH AVE SW
SEATTLE WA
98136-2349
US

V. Phone/Fax

Practice location:
  • Phone: 206-326-2135
  • Fax: 206-326-2010
Mailing address:
  • Phone: 206-326-2135
  • Fax: 206-326-2010

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code170300000X
TaxonomyGenetic Counselor (M.S.)
License Number
License Number StateWA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: