Provider Demographics
NPI:1700866936
Name:VANDER POL, HEIDI M (PSYD)
Entity Type:Individual
Prefix:DR
First Name:HEIDI
Middle Name:M
Last Name:VANDER POL
Suffix:
Gender:F
Credentials:PSYD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1904 3RD AVE STE 826
Mailing Address - Street 2:
Mailing Address - City:SEATTLE
Mailing Address - State:WA
Mailing Address - Zip Code:98101-1123
Mailing Address - Country:US
Mailing Address - Phone:206-713-6130
Mailing Address - Fax:206-686-5058
Practice Address - Street 1:1904 3RD AVENUE
Practice Address - Street 2:STE 826
Practice Address - City:SEATTLE
Practice Address - State:WA
Practice Address - Zip Code:98101-1123
Practice Address - Country:US
Practice Address - Phone:206-713-6130
Practice Address - Fax:206-686-5058
Is Sole Proprietor?:Yes
Enumeration Date:2006-01-23
Last Update Date:2022-08-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WAPY00003123103T00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103T00000XBehavioral Health & Social Service ProvidersPsychologist
Provider Identifiers
StateIdentifier IDID TypeIssuer
8850743Medicare ID - Type Unspecified