Provider Demographics
NPI:1598364432
Name:PENNY, HEATHER RAE (AAC, CPC)
Entity Type:Individual
Prefix:
First Name:HEATHER
Middle Name:RAE
Last Name:PENNY
Suffix:
Gender:F
Credentials:AAC, CPC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2109 CENTRAL ST NE
Mailing Address - Street 2:
Mailing Address - City:OLYMPIA
Mailing Address - State:WA
Mailing Address - Zip Code:98506-3496
Mailing Address - Country:US
Mailing Address - Phone:360-951-4165
Mailing Address - Fax:
Practice Address - Street 1:7610 40TH ST W STE 300
Practice Address - Street 2:
Practice Address - City:UNIVERSITY PLACE
Practice Address - State:WA
Practice Address - Zip Code:98466-3834
Practice Address - Country:US
Practice Address - Phone:253-830-6242
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2020-10-21
Last Update Date:2020-10-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101Y00000XBehavioral Health & Social Service ProvidersCounselor