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General NPI Number Information
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NPI Number | 1598488272
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Entity Type | Individual
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Provider Name | HEATHER BRADSHAW
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Gender | Female
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Dates
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Enumeration Date | 09/19/2022
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Last Update Date | 09/19/2022
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Provider Practice Location Address
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Address Line | 38579 SE RIVER ST
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City | SNOQUALMIE
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State | WA
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Zip | 98065-5155
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Country | US
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Telephone | 425-623-5101
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Fax |
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Provider Business Mailing Address
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Address Line | 6511 E CREST VIEW LOOP SE
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City | SNOQUALMIE
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State | WA
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Zip | 98065-8918
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Country | US
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Telephone | 425-837-2562
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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 | 101YP2500X
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Taxonomy Name | Professional Counselor
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License Number | MC61164782
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License Number State | WA
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