Provider Demographics
NPI:1720111495
Name:DELVIN, HEATHER RAIN (LMP)
Entity type:Individual
Prefix:
First Name:HEATHER
Middle Name:RAIN
Last Name:DELVIN
Suffix:
Gender:F
Credentials:LMP
Other - Prefix:
Other - First Name:RAIN
Other - Middle Name:
Other - Last Name:DELVIN
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:LAC, MAOM, LMP
Mailing Address - Street 1:2020 1/2 JACKSON AVE NW
Mailing Address - Street 2:HEALING ROOTS, LLC
Mailing Address - City:OLYMPIA
Mailing Address - State:WA
Mailing Address - Zip Code:98502
Mailing Address - Country:US
Mailing Address - Phone:360-754-1823
Mailing Address - Fax:
Practice Address - Street 1:2020 1/2 JACKSON AVE NW
Practice Address - Street 2:HEALING ROOTS, LLC
Practice Address - City:OLYMPIA
Practice Address - State:WA
Practice Address - Zip Code:98502
Practice Address - Country:US
Practice Address - Phone:360-754-1823
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-03-13
Last Update Date:2007-11-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WAAC00003057171100000X
WAMA-00014449225700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171100000XOther Service ProvidersAcupuncturist
No225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage Therapist