MEDICARE: LYLAH HEIDER SOCM

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	171000000X	Military Health Care Provider

General Provider Information

NPI Number	:	1770428781
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	LYLAH HEIDER SOCM

Provider Business Mailing Address
First Line	:	7533 WOODS LAKE RD
Second Line	:
City	:	MONROE
State	:	WA
Zip	:	98272-7808
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	7533 WOODS LAKE RD
Second Line	:
City	:	MONROE
State	:	WA
Zip	:	98272-7808
Country	:	US
Telephone Number	:	425-551-0991
Fax Number	:

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

Provider Enumeration Date	:	04/23/2026
Last Update Date	:	04/23/2026

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Directions to “ LYLAH HEIDER SOCM” Practice Location

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