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NPI Code Detail

MEDICARE: HEIDI JEAN NICHOLS CBT

MEDICARE: HEIDI JEAN NICHOLS CBT
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
1106S00000XBehavior Technician70092966WA

General Provider Information

NPI Number : 1104778943
Entity Type Code : Individual
Provider Name (Legal Business Name) : HEIDI JEAN NICHOLS CBT
Provider Business Mailing Address
First Line : 1718 E LINCOLN RD APT J168
Second Line :
City : SPOKANE
State : WA
Zip : 99217-7763
Country : US
Telephone Number : 509-216-9062
Fax Number :
Provider Business Practice Location Address
First Line : 16201 E INDIANA AVE STE 3400
Second Line :
City : SPOKANE VALLEY
State : WA
Zip : 99216-2830
Country : US
Telephone Number : 509-900-3669
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 02/13/2026
Last Update Date : 04/28/2026

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Directions to “ HEIDI JEAN NICHOLS CBT” Practice Location

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