Provider Demographics
NPI:1639367915
Name:SWAILES, HEIDI ROBIN (MC)
Entity Type:Individual
Prefix:MRS
First Name:HEIDI
Middle Name:ROBIN
Last Name:SWAILES
Suffix:
Gender:F
Credentials:MC
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 1525
Mailing Address - Street 2:
Mailing Address - City:BELLEVUE
Mailing Address - State:WA
Mailing Address - Zip Code:98009-1525
Mailing Address - Country:US
Mailing Address - Phone:425-688-0033
Mailing Address - Fax:425-688-0030
Practice Address - Street 1:12501 BEL RED RD
Practice Address - Street 2:SUITE 206
Practice Address - City:BELLEVUE
Practice Address - State:WA
Practice Address - Zip Code:98005-2509
Practice Address - Country:US
Practice Address - Phone:425-688-0033
Practice Address - Fax:425-688-0030
Is Sole Proprietor?:No
Enumeration Date:2007-10-11
Last Update Date:2007-10-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WACP00000866101YA0400X
WALH00003686101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health
No101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)