Individual provider Active NPI

Heather Elaine Soares, PH.D.

  • Psychologist
  • Spokane, WA
National Provider Identifier
1295030328
Registry record updated Apr 13, 2018
On this page

Key facts

NPPES NPI Registry
Primary specialty
PsychologistTaxonomy code 103T00000X
License
PY60339398 Issued in WA
Practice address
107 S Division St
Spokane, WA 99202-1510
Phone
(509) 838-4651
Fax
(509) 363-2762
NPI assigned
Jan 20, 2011
Sex
Female
Sole proprietor
Yes

NPPES NPI Registry

Updated by the provider on Apr 13, 2018

Registry information is reported by the provider to CMS and is not verified. About this source

Specialties & licenses 2

Specialty (taxonomy)CodeLicenseStatePrimary
Forensic Psychologist 103TF0200X PSY23824 CA
Psychologist 103T00000X PY60339398 WA Primary

Addresses

Primary practice location

107 S Division St
Spokane, WA 99202-1510

Mailing address

107 S Division St
Spokane, WA 99202-1510
Phone (509) 838-4651

Other identifiers 1

IdentifierTypeStateIssuer
1295030328MedicaidWA

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Not listed in the public Medicare enrollment file
Eligible to order & refer
  • Part B services: Yes
  • Medical equipment: Yes
  • Home health: No
  • Power mobility devices: No
  • Hospice: No
Green means eligible to order or refer.

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled
Credentials
Doctor of Philosophy

State licenses

LicenseStateTypeSpecialty
PY60339398WAMDPsychologist
PSY23824CAMDForensic Psychologist

NPI Registry JSON

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1295481600000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1523577600000",
    "number": "1295030328",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "107 S DIVISION ST",
            "city": "SPOKANE",
            "state": "WA",
            "postal_code": "992021510",
            "telephone_number": "509-838-4651",
            "fax_number": "509-363-2762"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "107 S DIVISION ST",
            "city": "SPOKANE",
            "state": "WA",
            "postal_code": "992021510",
            "telephone_number": "509-838-4651",
            "fax_number": "509-363-2762"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "SOARES",
        "first_name": "HEATHER",
        "middle_name": "ELAINE",
        "name_prefix": "Dr.",
        "credential": "PH.D.",
        "sole_proprietor": "YES",
        "sex": "F",
        "enumeration_date": "2011-01-20",
        "last_updated": "2018-04-13",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "103TF0200X",
            "taxonomy_group": "",
            "desc": "Psychologist, Forensic",
            "state": "CA",
            "license": "PSY23824",
            "primary": false
        },
        {
            "code": "103T00000X",
            "taxonomy_group": "",
            "desc": "Psychologist",
            "state": "WA",
            "license": "PY60339398",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "1295030328",
            "state": "WA"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Spokane, WA

Sources for this page

Verify at the official NPI Registry.