Provider Demographics
NPI:1942437728
Name:LOCK, HEATHER T (LMP)
Entity Type:Individual
Prefix:
First Name:HEATHER
Middle Name:T
Last Name:LOCK
Suffix:
Gender:F
Credentials:LMP
Other - Prefix:
Other - First Name:HEATHER
Other - Middle Name:T
Other - Last Name:FISK
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:HEATHER LOCK
Mailing Address - Street 1:2310 N CHERRY ST STE 200
Mailing Address - Street 2:
Mailing Address - City:SPOKANE VALLEY
Mailing Address - State:WA
Mailing Address - Zip Code:99216-1152
Mailing Address - Country:US
Mailing Address - Phone:509-993-6393
Mailing Address - Fax:928-223-6393
Practice Address - Street 1:2310 N CHERRY ST STE 200
Practice Address - Street 2:
Practice Address - City:SPOKANE VALLEY
Practice Address - State:WA
Practice Address - Zip Code:99216-1152
Practice Address - Country:US
Practice Address - Phone:509-993-6393
Practice Address - Fax:928-223-6393
Is Sole Proprietor?:Yes
Enumeration Date:2009-06-18
Last Update Date:2009-06-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WAMA00015750174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes174400000XOther Service ProvidersSpecialist