Provider Information for 1588057004
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CARMEN HEIDECKE CRC, LPC
Other Names:Former Name:CARMEN HUXSex: Female
NPI: 1588057004
Last Updated: 2016-04-18
Certification Date:
Certification Date:
Details
| Name | Value | ||||||||
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| NPI | 1588057004 | ||||||||
| Enumeration Date | 2015-03-08 | ||||||||
| NPI Type | NPI-1 Individual | ||||||||
| Sole Proprietor | NO | ||||||||
| Status | Active | ||||||||
| Mailing Address | 715 SW RAMSEY AVE GRANTS PASS, OR 97527-5500 United States Phone: 541-956-4943 | Fax: | ||||||||
| Primary Practice Address | 4347 SUNNYVIEW RD. NE SALEM, OR 97305 United States Phone: 541-956-4943 | Fax: | ||||||||
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