Provider Demographics
NPI:1326270521
Name:MARSOLEK, HEIDI LUCINDA DAWN (MA, LMHC)
Entity Type:Individual
Prefix:
First Name:HEIDI
Middle Name:LUCINDA DAWN
Last Name:MARSOLEK
Suffix:
Gender:F
Credentials:MA, LMHC
Other - Prefix:
Other - First Name:HEIDI
Other - Middle Name:LUCINDA DAWN
Other - Last Name:SHENK
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:MA, LMHC
Mailing Address - Street 1:18507 89TH AVE NE
Mailing Address - Street 2:
Mailing Address - City:BOTHELL
Mailing Address - State:WA
Mailing Address - Zip Code:98011-8139
Mailing Address - Country:US
Mailing Address - Phone:425-293-3161
Mailing Address - Fax:
Practice Address - Street 1:901 BOREN AVE STE 115
Practice Address - Street 2:
Practice Address - City:SEATTLE
Practice Address - State:WA
Practice Address - Zip Code:98104-3595
Practice Address - Country:US
Practice Address - Phone:425-870-2198
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2009-08-20
Last Update Date:2021-02-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
102L00000X, 101YM0800X
WARC60070012390200000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health
No102L00000XBehavioral Health & Social Service ProvidersPsychoanalyst
No390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program
Provider Identifiers
StateIdentifier IDID TypeIssuer
WA2170242Medicaid