Provider Demographics
NPI:1508544537
Name:HEATER, BENJAMIN ROSS (M ED)
Entity Type:Individual
Prefix:MR
First Name:BENJAMIN
Middle Name:ROSS
Last Name:HEATER
Suffix:
Gender:M
Credentials:M ED
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:19803 1ST AVE S STE 200
Mailing Address - Street 2:
Mailing Address - City:NORMANDY PARK
Mailing Address - State:WA
Mailing Address - Zip Code:98148-2410
Mailing Address - Country:US
Mailing Address - Phone:206-870-7549
Mailing Address - Fax:
Practice Address - Street 1:19803 1ST AVE S STE 200
Practice Address - Street 2:
Practice Address - City:NORMANDY PARK
Practice Address - State:WA
Practice Address - Zip Code:98148-2410
Practice Address - Country:US
Practice Address - Phone:206-870-7549
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2023-07-10
Last Update Date:2023-07-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WAMC61436560101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health