MEDICARE: ANGELA MARIE HEARD CDPT.CO.60339829

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
1	101YA0400X	Addiction (Substance Use Disorder) Counselor	CDPT.CO.60339829	WA

General Provider Information

NPI Number	:	1376474114
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	ANGELA MARIE HEARD CDPT.CO.60339829

Provider Business Mailing Address
First Line	:	2303 S WENAS RD
Second Line	:
City	:	SELAH
State	:	WA
Zip	:	98942-9155
Country	:	US
Telephone Number	:	509-902-4744
Fax Number	:

Provider Business Practice Location Address
First Line	:	2303 S WENAS RD
Second Line	:
City	:	SELAH
State	:	WA
Zip	:	98942-9155
Country	:	US
Telephone Number	:	509-902-4744
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	05/28/2026
Last Update Date	:	05/28/2026

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