1679920078 NPI number — DR. CARLY JEAN HEFFEL PH.D.

Table of content: DR. CARLY JEAN HEFFEL PH.D. (NPI 1679920078)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1679920078 NPI number — DR. CARLY JEAN HEFFEL PH.D.

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
HEFFEL
Provider First Name:
CARLY
Provider Middle Name:
JEAN
Provider Name Prefix Text:
DR.
Provider Name Suffix Text:
Provider Credential Text:
PH.D.
Provider Gender Code:
F

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1679920078
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
05/16/2016
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
7, 1441 23 AVE SW
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
CALGARY
Provider Business Mailing Address State Name:
ALBERTA
Provider Business Mailing Address Postal Code:
T2T0T6
Provider Business Mailing Address Country Code:
CA
Provider Business Mailing Address Telephone Number:
587-433-3304
Provider Business Mailing Address Fax Number:

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
4800 SAND POINT WAY NE
Provider Second Line Business Practice Location Address:
M/S REHABILITATION PSYCHOLOGY
Provider Business Practice Location Address City Name:
SEATTLE
Provider Business Practice Location Address State Name:
WA
Provider Business Practice Location Address Postal Code:
98105-3901
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
587-433-3304
Provider Business Practice Location Address Fax Number:
Provider Enumeration Date:
05/16/2016

Additional Information

			
		

Authorized Official

Authorized Official Last Name:
Authorized Official First Name:
Authorized Official Middle Name:
Authorized Official Title or Position:
Authorized Official Telephone Number:

Provider Taxonomy Codes

  • Taxonomy code: 103T00000X , with the licence number:  PSYC.PY.60657348 , registered in the state of WA ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)