Basic Information
| Provider Information | |||||||||
| NPI: | 1508145731 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | HEGIE | ||||||||
| FirstName: | ALICIA | ||||||||
| MiddleName: | FAITH | ||||||||
| NamePrefix: | |||||||||
| NameSuffix: | |||||||||
| Credential: | |||||||||
| OtherOrganizationName: | |||||||||
| OtherOrganizationType: | |||||||||
| OtherLastName: | PLASTERER | ||||||||
| OtherFirstName: | ALICIA | ||||||||
| OtherMiddleName: | FAITH | ||||||||
| OtherNamePrefix: | |||||||||
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| OtherCredential: | |||||||||
| OtherLastNameType: | 1 | ||||||||
| Mailing Information | |||||||||
| Address1: | PO BOX 469 | ||||||||
| Address2: | |||||||||
| City: | SPOKANE | ||||||||
| State: | WA | ||||||||
| PostalCode: | 992100469 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 5094736000 | ||||||||
| FaxNumber: | |||||||||
| Practice Location | |||||||||
| Address1: | 711 S COWLEY ST | ||||||||
| Address2: | |||||||||
| City: | SPOKANE | ||||||||
| State: | WA | ||||||||
| PostalCode: | 992021388 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 5097235432 | ||||||||
| FaxNumber: | |||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 08/05/2011 | ||||||||
| LastUpdateDate: | 01/07/2019 | ||||||||
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| NPIReactivationDate: | |||||||||
| ProviderGenderCode: | F | ||||||||
| AuthorizedOfficialLastName: | |||||||||
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| AuthorizedOfficialMiddleName: | |||||||||
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| IsSoleProprietor: | N | ||||||||
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| NPICertificationDate: | |||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 103T00000X | PY60324091 | WA | N | Behavioral Health & Social Service Providers | Psychologist | 103TC0700X | PY60324091 | WA | N | Behavioral Health & Social Service Providers | Psychologist | Clinical | 103G00000X | 60324091 | WA | Y | Behavioral Health & Social Service Providers | Clinical Neuropsychologist |
No ID Information.