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General NPI Number Information
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NPI Number | 1417762246
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Entity Type | Individual
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Provider Name | MARIA HEDERICH PEREZ
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Gender | Female
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Dates
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Enumeration Date | 02/10/2025
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Last Update Date | 02/10/2025
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Provider Practice Location Address
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Address Line | 12812 101ST AVE CT E
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City | PUYALLUP
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State | WA
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Zip | 98373
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Country | US
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Telephone | 253-864-4770
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Fax |
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Provider Business Mailing Address
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Address Line | 407 VALLEY AVE NE A303
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City | PUYALLUP
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State | WA
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Zip | 98372
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Country | US
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Telephone | 253-961-3797
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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 | 103TC0700X
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Taxonomy Name | Clinical Psychologist
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License Number | CG61627992
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License Number State | WA
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