Provider Demographics
NPI:1417292657
Name:GAEDT, HEATHER A (PSYD)
Entity Type:Individual
Prefix:DR
First Name:HEATHER
Middle Name:A
Last Name:GAEDT
Suffix:
Gender:F
Credentials:PSYD
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 2542
Mailing Address - Street 2:
Mailing Address - City:PALM DESERT
Mailing Address - State:CA
Mailing Address - Zip Code:92261-2542
Mailing Address - Country:US
Mailing Address - Phone:760-834-1586
Mailing Address - Fax:
Practice Address - Street 1:74040 HIGHWAY 111 STE J4
Practice Address - Street 2:
Practice Address - City:PALM DESERT
Practice Address - State:CA
Practice Address - Zip Code:92260-4159
Practice Address - Country:US
Practice Address - Phone:760-834-1586
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2012-11-28
Last Update Date:2014-05-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAPSY 25313103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical