Individual
HEATHER AMANDA DE LA FUENTE
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
PSYD
Contact information
Practice address
604 NW RICHMOND BEACH RD, SHORELINE, WA 98177-3122
(206) 533-2900
(206) 533-2901
Mailing address
PO BOX 25608, SALT LAKE CITY, UT 84125-0608
(206) 320-4476
(206) 568-7043
Taxonomy
Speciality
Code
Description
License number
State
103T00000X
Psychologist
PY61013388
WA
103TC0700X
Clinical Psychologist
Primary
PY61013388
WA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
2146862
—
WA
Enumeration date
11/07/2018
Last updated
09/27/2023
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