Healthcare Provider Details

I. General information

NPI: 1427343169
Provider Name (Legal Business Name): AILEEN MARIE HETRICK MSW
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 06/10/2011
Last Update Date: 05/19/2021
Certification Date: 05/19/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

16528 E DESMET CT STE B2100
SPOKANE VALLEY WA
99216-3522
US

IV. Provider business mailing address

107 S DIVISION ST
SPOKANE WA
99202-1510
US

V. Phone/Fax

Practice location:
  • Phone: 509-944-9440
  • Fax: 509-474-6606
Mailing address:
  • Phone: 509-838-4651
  • Fax: 509-363-2762

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code1041S0200X
TaxonomySchool Social Worker
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License NumberLW60584181
License Number StateWA
# 3
Primary TaxonomyY
Taxonomy Code104100000X
TaxonomySocial Worker
License NumberLW60584181
License Number StateWA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: