Healthcare Provider Details

I. General information

NPI: 1295030328
Provider Name (Legal Business Name): HEATHER ELAINE SOARES PH.D.
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 01/20/2011
Last Update Date: 04/13/2018
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

107 S DIVISION ST
SPOKANE WA
99202-1510
US

IV. Provider business mailing address

107 S DIVISION ST
SPOKANE WA
99202-1510
US

V. Phone/Fax

Practice location:
  • Phone: 509-838-4651
  • Fax: 509-363-2762
Mailing address:
  • Phone: 509-838-4651
  • Fax: 509-363-2762

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code103T00000X
TaxonomyPsychologist
License NumberPY60339398
License Number StateWA
# 2
Primary TaxonomyN
Taxonomy Code103TF0200X
TaxonomyForensic Psychologist
License NumberPSY23824
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: