Healthcare Provider Details

I. General information

NPI: 1427640929
Provider Name (Legal Business Name): HEATHER SCHUCK LICSW PIP
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 02/05/2021
Last Update Date: 06/23/2026
Certification Date: 06/23/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

400 VESTAVIA PKWY STE 406
VESTAVIA AL
35216-3763
US

IV. Provider business mailing address

861 SHADES CREST RD
BIRMINGHAM AL
35226-1973
US

V. Phone/Fax

Practice location:
  • Phone: 205-210-9096
  • Fax:
Mailing address:
  • Phone: 205-422-5001
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License Number1522-4291C
License Number StateAL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: