Healthcare Provider Details

I. General information

NPI: 1023294188
Provider Name (Legal Business Name): SARAH MARIE HEFFEL
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

Provider Other Name: SARAH MARIE VAN CLEAVE

II. Dates (important events)

Enumeration Date: 01/18/2008
Last Update Date: 01/18/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

19680 S 188TH ST
QUEEN CREEK AZ
85242-7067
US

IV. Provider business mailing address

2935 S RECKER RD
GILBERT AZ
85295-7846
US

V. Phone/Fax

Practice location:
  • Phone: 480-274-7184
  • Fax:
Mailing address:
  • Phone: 480-274-7814
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YS0200X
TaxonomySchool Counselor
License Number3993604
License Number StateAZ

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: