Provider Demographics
NPI:1609351618
Name:TAFT, HEATHER KRISTIN (CDPT)
Entity Type:Individual
Prefix:MS
First Name:HEATHER
Middle Name:KRISTIN
Last Name:TAFT
Suffix:
Gender:F
Credentials:CDPT
Other - Prefix:MS
Other - First Name:HEATHER
Other - Middle Name:K
Other - Last Name:TAFT
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:CDPT
Mailing Address - Street 1:9720 S TACOMA WAY
Mailing Address - Street 2:
Mailing Address - City:LAKEWOOD
Mailing Address - State:WA
Mailing Address - Zip Code:98499-4456
Mailing Address - Country:US
Mailing Address - Phone:253-503-3666
Mailing Address - Fax:
Practice Address - Street 1:9720 S TACOMA WAY
Practice Address - Street 2:
Practice Address - City:LAKEWOOD
Practice Address - State:WA
Practice Address - Zip Code:98499-4456
Practice Address - Country:US
Practice Address - Phone:253-503-3666
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2018-09-26
Last Update Date:2018-09-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WACO60824033101YA0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)
Provider Identifiers
StateIdentifier IDID TypeIssuer
WA101YA0400XMedicaid