Provider Demographics
NPI:1609413517
Name:HECKLER, MARANDA RAE (BS, R-AAC)
Entity type:Individual
Prefix:
First Name:MARANDA
Middle Name:RAE
Last Name:HECKLER
Suffix:
Gender:F
Credentials:BS, R-AAC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 2394
Mailing Address - Street 2:
Mailing Address - City:LONGVIEW
Mailing Address - State:WA
Mailing Address - Zip Code:98632-8455
Mailing Address - Country:US
Mailing Address - Phone:360-200-5419
Mailing Address - Fax:360-200-6736
Practice Address - Street 1:1400 COMMERCE AVE
Practice Address - Street 2:
Practice Address - City:LONGVIEW
Practice Address - State:WA
Practice Address - Zip Code:98632-3756
Practice Address - Country:US
Practice Address - Phone:360-998-2047
Practice Address - Fax:360-200-6736
Is Sole Proprietor?:No
Enumeration Date:2019-12-10
Last Update Date:2024-08-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
390200000X
WACG61027902101Y00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101Y00000XBehavioral Health & Social Service ProvidersCounselor
No390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program