Active NPI
Heather Elaine Soares, PH.D.
- Psychologist
- Spokane, WA
National Provider Identifier
1295030328
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Psychologist
- License
- PY60339398
- 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
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 2
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| 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
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1295030328 | Medicaid | WA |
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
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Enrolled
- Credentials
- Doctor of Philosophy
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| PY60339398 | WA | MD | Psychologist |
| PSY23824 | CA | MD | Forensic 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
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Apr 13, 2018; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments; Order and Referring.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.