=====================================================
General NPI Number Information
=====================================================
NPI Number | 1982393724
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | HERA PATHWAYS PLLC
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 05/08/2023
-----------------------------------------------------
Last Update Date | 05/08/2023
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 8856 34TH AVE SW
-----------------------------------------------------
City | SEATTLE
-----------------------------------------------------
State | WA
-----------------------------------------------------
Zip | 98126-3727
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 765-491-1415
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 8856 34TH AVE SW
-----------------------------------------------------
City | SEATTLE
-----------------------------------------------------
State | WA
-----------------------------------------------------
Zip | 98126-3727
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 765-491-1415
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | OWNER
-----------------------------------------------------
Name | CATHLYN MARIE FRAGUELA RIOS
-----------------------------------------------------
Credential | LICSW
-----------------------------------------------------
Telephone | 765-491-1415
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 261QM0801X
-----------------------------------------------------
Taxonomy Name | Mental Health Clinic/Center (Including Community Mental Health Center)
-----------------------------------------------------
License Number |
-----------------------------------------------------
License Number State |
-----------------------------------------------------