Healthcare Provider Details

I. General information

NPI: 1083526495
Provider Name (Legal Business Name): KATELYN ROSE HECKLER LMSW
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 09/21/2026
Last Update Date: 09/21/2026
Certification Date: 09/21/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1325 SATELLITE BLVD NW BLDG 500
SUWANEE GA
30024-5665
US

IV. Provider business mailing address

3306 TREE CORNERS PKWY APT 3306
PEACHTREE CORNERS GA
30092-3156
US

V. Phone/Fax

Practice location:
  • Phone: 678-263-3080
  • Fax: 833-941-5042
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code104100000X
TaxonomySocial Worker
License NumberMSW013527
License Number StateGA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: