Provider Demographics
NPI:1982994364
Name:HERO HOUSE
Entity type:Organization
Organization Name:HERO HOUSE
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:EXECUTIVE DIRECTOR
Authorized Official - Prefix:
Authorized Official - First Name:KAILEY
Authorized Official - Middle Name:
Authorized Official - Last Name:FIEDLER-GOHLKE
Authorized Official - Suffix:
Authorized Official - Credentials:MA, CRC
Authorized Official - Phone:425-614-1282
Mailing Address - Street 1:12838 SE 40TH PL
Mailing Address - Street 2:
Mailing Address - City:BELLEVUE
Mailing Address - State:WA
Mailing Address - Zip Code:98006
Mailing Address - Country:US
Mailing Address - Phone:425-614-1282
Mailing Address - Fax:425-614-1294
Practice Address - Street 1:12838 SE 40TH PL
Practice Address - Street 2:
Practice Address - City:BELLEVUE
Practice Address - State:WA
Practice Address - Zip Code:98006
Practice Address - Country:US
Practice Address - Phone:425-614-1282
Practice Address - Fax:425-614-1294
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2011-04-19
Last Update Date:2018-06-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WA602931844251S00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251S00000XAgenciesCommunity/Behavioral Health