Provider Demographics
NPI:1700400702
Name:HEDUM, HEATHER (CDP)
Entity Type:Individual
Prefix:
First Name:HEATHER
Middle Name:
Last Name:HEDUM
Suffix:
Gender:F
Credentials:CDP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:104 S FREYA ST STE 206
Mailing Address - Street 2:
Mailing Address - City:SPOKANE
Mailing Address - State:WA
Mailing Address - Zip Code:99202-4889
Mailing Address - Country:US
Mailing Address - Phone:509-927-3668
Mailing Address - Fax:509-892-6661
Practice Address - Street 1:104 S FREYA ST STE 206
Practice Address - Street 2:
Practice Address - City:SPOKANE
Practice Address - State:WA
Practice Address - Zip Code:99202-4889
Practice Address - Country:US
Practice Address - Phone:509-927-3668
Practice Address - Fax:509-892-6661
Is Sole Proprietor?:No
Enumeration Date:2020-06-04
Last Update Date:2020-06-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WACP60921296101YA0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)