Healthcare Provider Details

I. General information

NPI: 1073785267
Provider Name (Legal Business Name): PATRICIA CHRISTINE HEFFERN MSW, CADC
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 03/27/2008
Last Update Date: 01/23/2024
Certification Date: 01/23/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

41W400 SILVER GLEN RD
ST CHARLES IL
60175-8453
US

IV. Provider business mailing address

41W400 SILVER GLEN RD
SAINT CHARLES IL
60175-8453
US

V. Phone/Fax

Practice location:
  • Phone: 630-940-1100
  • Fax:
Mailing address:
  • Phone: 630-940-1100
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YA0400X
TaxonomyAddiction (Substance Use Disorder) Counselor
License Number150.111945
License Number StateIL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: