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General NPI Number Information
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NPI Number | 1104555820
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Entity Type | Individual
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Provider Name | HEATHER HETH ED.S.
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Gender | Female
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Dates
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Enumeration Date | 06/08/2022
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Last Update Date | 06/08/2022
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Provider Practice Location Address
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Address Line | 619 WEST 5TH STREET
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City | LUSK
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State | WY
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Zip | 82225-8222
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Country | US
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Telephone | 307-334-2224
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Fax |
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Provider Business Mailing Address
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Address Line | PO BOX 629
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City | LUSK
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State | WY
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Zip | 82225-0629
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Country | US
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Telephone | 307-334-2224
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 103TS0200X
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Taxonomy Name | School Psychologist
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License Number | 74040
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License Number State | WY
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