Provider Demographics
NPI:1336946557
Name:CEDERBLOM, HEATHER MARIE (SUDPT)
Entity type:Individual
Prefix:
First Name:HEATHER
Middle Name:MARIE
Last Name:CEDERBLOM
Suffix:
Gender:
Credentials:SUDPT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4305 E TRENT AVE
Mailing Address - Street 2:
Mailing Address - City:SPOKANE
Mailing Address - State:WA
Mailing Address - Zip Code:99212-1315
Mailing Address - Country:US
Mailing Address - Phone:509-381-7011
Mailing Address - Fax:509-795-3141
Practice Address - Street 1:4305 E TRENT AVE
Practice Address - Street 2:
Practice Address - City:SPOKANE
Practice Address - State:WA
Practice Address - Zip Code:99212-1315
Practice Address - Country:US
Practice Address - Phone:509-381-7011
Practice Address - Fax:509-795-3141
Is Sole Proprietor?:No
Enumeration Date:2025-02-26
Last Update Date:2025-02-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WACO61649485101YA0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)