Basic Information
Provider Information
NPI: 1083224752
EntityType: 1
ReplacementNPI:  
OrganizationName:  
LastName: HEHN
FirstName: KIARRA
MiddleName: Q
NamePrefix:  
NameSuffix:  
Credential:  
OtherOrganizationName:  
OtherOrganizationType:  
OtherLastName:  
OtherFirstName:  
OtherMiddleName:  
OtherNamePrefix:  
OtherNameSuffix:  
OtherCredential:  
OtherLastNameType:  
Mailing Information
Address1: 6400 SOUTHCENTER BLVD
Address2:  
City: TUKWILA
State: WA
PostalCode: 981882547
CountryCode: US
TelephoneNumber: 2069012000
FaxNumber: 2069012010
Practice Location
Address1: 4238 AUBURN WAY N
Address2:  
City: AUBURN
State: WA
PostalCode: 980021311
CountryCode: US
TelephoneNumber: 2538767600
FaxNumber: 2538767610
Other Information
ProviderEnumerationDate: 08/06/2020
LastUpdateDate: 08/06/2020
NPIDeactivationReasonCode:  
NPIDeactivationDate:  
NPIReactivationDate:  
ProviderGenderCode: F
AuthorizedOfficialLastName:  
AuthorizedOfficialFirstName:  
AuthorizedOfficialMiddleName:  
AuthorizedOfficialTitleorPosition:  
AuthorizedOfficialTelephone:  
IsSoleProprietor: N
IsOrganizationSubpart:  
ParentOrganizationLBN:  
AuthorizedOfficialNamePrefix:  
AuthorizedOfficialNameSuffix:  
AuthorizedOfficialCredential:  
NPICertificationDate: 08/06/2020

Taxonomy Information
TaxonomyLicenseStateSwitchTaxonomyGroupTaxonomyTypeTaxonomyClassSubSpecialty
101Y00000X  N Behavioral Health & Social Service ProvidersCounselor 
390200000X  Y Student, Health CareStudent in an Organized Health Care Education/Training Program 

No ID Information.


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