Individual
HEATHER ANN IVY
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
SUDP III
Contact information
Practice address
1415 CENTER ST, TACOMA, WA 98409-8210
(253) 280-9860
(253) 280-9870
Mailing address
9650 15TH AVE SW, SEATTLE, WA 98106-2576
(206) 965-1055
(206) 965-1032
Taxonomy
Speciality
Code
Description
License number
State
101YA0400X
Addiction (Substance Use Disorder) Counselor
Primary
CP61678744
WA
390200000X
Student in an Organized Health Care Education/Training Program
CO61296221
WA
Other
Enumeration date
03/02/2023
Last updated
07/08/2025
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