Provider Demographics
NPI:1912178286
Name:HEAVERLO, MARTHA S (HS)
Entity Type:Individual
Prefix:MS
First Name:MARTHA
Middle Name:S
Last Name:HEAVERLO
Suffix:
Gender:F
Credentials:HS
Other - Prefix:MS
Other - First Name:MARTHA
Other - Middle Name:S
Other - Last Name:OWINGS
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:HS
Mailing Address - Street 1:9330 59TH AVE SW
Mailing Address - Street 2:
Mailing Address - City:LAKEWOOD
Mailing Address - State:WA
Mailing Address - Zip Code:98499-2858
Mailing Address - Country:US
Mailing Address - Phone:253-581-7020
Mailing Address - Fax:253-620-5831
Practice Address - Street 1:9330 59TH AVE SW
Practice Address - Street 2:
Practice Address - City:LAKEWOOD
Practice Address - State:WA
Practice Address - Zip Code:98499-2858
Practice Address - Country:US
Practice Address - Phone:253-581-7020
Practice Address - Fax:253-620-5831
Is Sole Proprietor?:No
Enumeration Date:2008-03-14
Last Update Date:2008-03-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)