Provider Demographics
NPI:1427302710
Name:DYK, HEIDI HRISTINE (BS)
Entity type:Individual
Prefix:MRS
First Name:HEIDI
Middle Name:HRISTINE
Last Name:DYK
Suffix:
Gender:F
Credentials:BS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1014 MAIN ST
Mailing Address - Street 2:
Mailing Address - City:VANCOUVER
Mailing Address - State:WA
Mailing Address - Zip Code:98660-3151
Mailing Address - Country:US
Mailing Address - Phone:360-910-7199
Mailing Address - Fax:360-750-1374
Practice Address - Street 1:1014 MAIN ST
Practice Address - Street 2:
Practice Address - City:VANCOUVER
Practice Address - State:WA
Practice Address - Zip Code:98660-3151
Practice Address - Country:US
Practice Address - Phone:360-910-7199
Practice Address - Fax:360-750-1374
Is Sole Proprietor?:Yes
Enumeration Date:2012-11-08
Last Update Date:2012-11-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WACG60304149101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health