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NPI Code Detail

MEDICARE: AUDREY RUTH HEINEN LISW

MEDICARE: AUDREY RUTH HEINEN LISW
Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

# Taxonomy Code Taxonomy License Number License Number State
11041C0700XClinical Social WorkerI7379OH

General Provider Information

NPI Number : 1548335102
Entity Type Code : Individual
Provider Name (Legal Business Name) : AUDREY RUTH HEINEN LISW
Provider Business Mailing Address
First Line : 17030 LEGGETT RD
Second Line :
City : MONTVILLE
State : OH
Zip : 44064-9721
Country : US
Telephone Number : 440-968-0183
Fax Number :
Provider Business Practice Location Address
First Line : 12557 RAVENWOOD DR
Second Line :
City : CHARDON
State : OH
Zip : 44024-9009
Country : US
Telephone Number : 440-285-3568
Fax Number : 440-285-4552
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 11/21/2006
Last Update Date : 07/08/2007

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Directions to “ AUDREY RUTH HEINEN LISW” Practice Location

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