Provider Demographics
NPI:1174195580
Name:SLATER, HEIDI JO
Entity Type:Individual
Prefix:MRS
First Name:HEIDI
Middle Name:JO
Last Name:SLATER
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:HEIDI
Other - Middle Name:JO
Other - Last Name:TIEL
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:4024 CASCADIA AVE S
Mailing Address - Street 2:
Mailing Address - City:SEATTLE
Mailing Address - State:WA
Mailing Address - Zip Code:98118-1131
Mailing Address - Country:US
Mailing Address - Phone:206-715-2355
Mailing Address - Fax:
Practice Address - Street 1:4024 CASCADIA AVE S
Practice Address - Street 2:
Practice Address - City:SEATTLE
Practice Address - State:WA
Practice Address - Zip Code:98118-1131
Practice Address - Country:US
Practice Address - Phone:206-715-2355
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2021-07-14
Last Update Date:2021-07-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WA604696900374J00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes374J00000XNursing Service Related ProvidersDoula