Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 101Y00000X | Counselor | CG60329478 | WA |
NPI | 1003152042 |
---|---|
Provider Name | Jolie Rae Heck |
First Address | Everett, WA 98213-8810 |
Second Address | Everett, WA 98201-4425 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 19/12/2012 |
Last Update Date | 19/12/2012 |