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NPI Code Detail

MEDICARE: MRS. HEIDI JOY LAURA THEISEN BA

MEDICARE:  MRS. HEIDI JOY LAURA THEISEN  BA
Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

# Taxonomy Code Taxonomy License Number License Number State
1101Y00000XCounselorWA

General Provider Information

NPI Number : 1013983980
Entity Type Code : Individual
Provider Name (Legal Business Name) : MRS. HEIDI JOY LAURA THEISEN BA
Provider Business Mailing Address
First Line : 5610 S PASS RD
Second Line :
City : SUMAS
State : WA
Zip : 98295
Country : US
Telephone Number : 360-988-0317
Fax Number :
Provider Business Practice Location Address
First Line : 4526 FEDERAL AVE
Second Line :
City : EVERETT
State : WA
Zip : 98203-2132
Country : US
Telephone Number : 425-349-6200
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 02/28/2006
Last Update Date : 12/01/2025

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Directions to “ MRS. HEIDI JOY LAURA THEISEN BA” Practice Location

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