Healthcare Provider Details

I. General information

NPI: 1174873681
Provider Name (Legal Business Name): SARAH A HEFFRON LMSW
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 09/12/2012
Last Update Date: 08/21/2019
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

480 S ROGERS RD
OLATHE KS
66062-1706
US

IV. Provider business mailing address

2108 NEW HAMPSHIRE ST
LAWRENCE KS
66046-3046
US

V. Phone/Fax

Practice location:
  • Phone: 913-764-2887
  • Fax: 913-780-3387
Mailing address:
  • Phone: 435-260-7271
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code104100000X
TaxonomySocial Worker
License Number11115
License Number StateKS
# 2
Primary TaxonomyN
Taxonomy Code390200000X
TaxonomyStudent in an Organized Health Care Education/Training Program
License Number
License Number StateNULL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: