MEDICARE: ANDREW K HEINTZ MSW

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	1041C0700X	Clinical Social Worker	LW00006467	WA

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	LW00006467	OTHER	WA	STATE LICENSE

General Provider Information

NPI Number	:	1497804546
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	ANDREW K HEINTZ MSW

Provider Business Mailing Address
First Line	:	9450 ETHAN WADE WAY SE
Second Line	:	SUITE B
City	:	SNOQUALMIE
State	:	WA
Zip	:	98065-9520
Country	:	US
Telephone Number	:	425-831-2300
Fax Number	:	425-831-2361

Provider Business Practice Location Address
First Line	:	213 BENDIGO BLVD N
Second Line	:	SUITE 1
City	:	NORTH BEND
State	:	WA
Zip	:	98045-8259
Country	:	US
Telephone Number	:	425-888-5130
Fax Number	:	425-888-5139

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

Provider Enumeration Date	:	01/09/2007
Last Update Date	:	07/08/2007

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