Provider Demographics
NPI:1700669660
Name:MCKAY-MADDOX, HEATHER SUSAN (MSN-HSL)
Entity Type:Individual
Prefix:
First Name:HEATHER
Middle Name:SUSAN
Last Name:MCKAY-MADDOX
Suffix:
Gender:F
Credentials:MSN-HSL
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:8190 SKAGIT WAY
Mailing Address - Street 2:
Mailing Address - City:BLAINE
Mailing Address - State:WA
Mailing Address - Zip Code:98230-9554
Mailing Address - Country:US
Mailing Address - Phone:206-390-3458
Mailing Address - Fax:
Practice Address - Street 1:1420 STATE ROUTE 20
Practice Address - Street 2:
Practice Address - City:SEDRO WOOLLEY
Practice Address - State:WA
Practice Address - Zip Code:98284-4322
Practice Address - Country:US
Practice Address - Phone:360-854-7400
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2023-08-15
Last Update Date:2023-08-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WA00120754163WP0808X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163WP0808XNursing Service ProvidersRegistered NursePsychiatric/Mental Health