Healthcare Provider Details

I. General information

NPI: 1558735910
Provider Name (Legal Business Name): KATHLEEN HEPPELL MA
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 11/23/2015
Last Update Date: 11/23/2015
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2104 N 30TH ST
TACOMA WA
98403-3319
US

IV. Provider business mailing address

2104 N 30TH ST
TACOMA WA
98403-3319
US

V. Phone/Fax

Practice location:
  • Phone: 253-376-7829
  • Fax:
Mailing address:
  • Phone: 253-376-7829
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License NumberMC 60288733
License Number StateWA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: