Healthcare Provider Details

I. General information

NPI: 1508145731
Provider Name (Legal Business Name): ALICIA FAITH HEGIE
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: ALICIA FAITH PLASTERER

II. Dates (important events)

Enumeration Date: 08/05/2011
Last Update Date: 01/07/2019
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

711 S COWLEY ST
SPOKANE WA
99202-1388
US

IV. Provider business mailing address

PO BOX 469
SPOKANE WA
99210-0469
US

V. Phone/Fax

Practice location:
  • Phone: 509-723-5432
  • Fax:
Mailing address:
  • Phone: 509-473-6000
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code103T00000X
TaxonomyPsychologist
License NumberPY60324091
License Number StateWA
# 2
Primary TaxonomyN
Taxonomy Code103TC0700X
TaxonomyClinical Psychologist
License NumberPY60324091
License Number StateWA
# 3
Primary TaxonomyY
Taxonomy Code103G00000X
TaxonomyClinical Neuropsychologist
License Number60324091
License Number StateWA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: