Provider Demographics
NPI:1114298288
Name:BROWN, HEIDI (CRC)
Entity Type:Individual
Prefix:
First Name:HEIDI
Middle Name:
Last Name:BROWN
Suffix:
Gender:F
Credentials:CRC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 2
Mailing Address - Street 2:
Mailing Address - City:DRYDEN
Mailing Address - State:WA
Mailing Address - Zip Code:98821-0002
Mailing Address - Country:US
Mailing Address - Phone:509-293-3786
Mailing Address - Fax:360-359-7003
Practice Address - Street 1:113 COTTAGE AVE
Practice Address - Street 2:B
Practice Address - City:CASHMERE
Practice Address - State:WA
Practice Address - Zip Code:98815-1001
Practice Address - Country:US
Practice Address - Phone:509-293-3786
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2012-01-22
Last Update Date:2012-01-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WA10082225C00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225C00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersRehabilitation Counselor