Provider Demographics
NPI:1164998910
Name:HEDIN, TANYA KATRINA
Entity Type:Individual
Prefix:
First Name:TANYA
Middle Name:KATRINA
Last Name:HEDIN
Suffix:
Gender:F
Credentials:
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 542
Mailing Address - Street 2:
Mailing Address - City:LAKE STEVENS
Mailing Address - State:WA
Mailing Address - Zip Code:98258-0542
Mailing Address - Country:US
Mailing Address - Phone:425-319-4112
Mailing Address - Fax:
Practice Address - Street 1:2735 10TH ST
Practice Address - Street 2:
Practice Address - City:EVERETT
Practice Address - State:WA
Practice Address - Zip Code:98201-1413
Practice Address - Country:US
Practice Address - Phone:425-349-6800
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2018-10-19
Last Update Date:2018-10-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health