Provider Demographics
NPI:1710353222
Name:THREADGILL, HEATHER
Entity Type:Individual
Prefix:
First Name:HEATHER
Middle Name:
Last Name:THREADGILL
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:HEATHER
Other - Middle Name:
Other - Last Name:THREADGILL
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:MSW
Mailing Address - Street 1:1102 S RAYMOND RD
Mailing Address - Street 2:
Mailing Address - City:SPOKANE VALLEY
Mailing Address - State:WA
Mailing Address - Zip Code:99206-3534
Mailing Address - Country:US
Mailing Address - Phone:509-892-4342
Mailing Address - Fax:509-928-2804
Practice Address - Street 1:1102 S RAYMOND RD
Practice Address - Street 2:
Practice Address - City:SPOKANE VALLEY
Practice Address - State:WA
Practice Address - Zip Code:99206-3534
Practice Address - Country:US
Practice Address - Phone:509-892-4342
Practice Address - Fax:509-928-2804
Is Sole Proprietor?:No
Enumeration Date:2015-08-19
Last Update Date:2019-10-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
WACG61006495Medicaid
IDLCSW38183Medicaid