Healthcare Provider Details

I. General information

NPI: 1124355672
Provider Name (Legal Business Name): STEVEN MICHAEL HEUERTZ MA, LCSW
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 11/04/2009
Last Update Date: 01/06/2016
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1755 PARK ST STE 200
NAPERVILLE IL
60563-8404
US

IV. Provider business mailing address

1755 PARK ST STE 200
NAPERVILLE IL
60563-8404
US

V. Phone/Fax

Practice location:
  • Phone: 630-778-3476
  • Fax: 630-300-3630
Mailing address:
  • Phone: 630-778-3476
  • Fax: 630-300-3630

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License Number149014001
License Number StateIL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: