Healthcare Provider Details

I. General information

NPI: 1215034269
Provider Name (Legal Business Name): LEE ELLEN HECKERMAN LSCSW
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

Provider Other Name: LEE ELLEN PATTERSON

II. Dates (important events)

Enumeration Date: 09/20/2006
Last Update Date: 10/07/2024
Certification Date: 10/03/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1900 E. WASHINGTON
FREDONIA KS
66063
US

IV. Provider business mailing address

4909 SCOTT RD
NEODESHA KS
66757-1694
US

V. Phone/Fax

Practice location:
  • Phone: 620-378-3434
  • Fax:
Mailing address:
  • Phone: 316-619-1101
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License Number1953
License Number StateKS

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: