Healthcare Provider Details

I. General information

NPI: 1376594226
Provider Name (Legal Business Name): SANDRA T HARTMANN-HEISSERER LCSW
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/15/2006
Last Update Date: 07/16/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2345 S LYNHURST DR
INDIANAPOLIS IN
46241-8630
US

IV. Provider business mailing address

11221 BAYWOOD LN
INDIANAPOLIS IN
46236-9097
US

V. Phone/Fax

Practice location:
  • Phone: 317-247-8918
  • Fax: 317-381-0619
Mailing address:
  • Phone: 317-823-7471
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License Number34005040A
License Number StateIN

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: