Healthcare Provider Details

I. General information

NPI: 1164890059
Provider Name (Legal Business Name): HEATHER WEBB
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 09/09/2015
Last Update Date: 11/17/2016
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1048 ASHLEY ST SUITE 201
BOWLING GREEN KY
42103-2449
US

IV. Provider business mailing address

104 REYNOLDS RD
GLASGOW KY
42141-1177
US

V. Phone/Fax

Practice location:
  • Phone: 270-904-6567
  • Fax: 270-904-6570
Mailing address:
  • Phone: 270-678-4801
  • Fax: 270-678-3866

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code104100000X
TaxonomySocial Worker
License Number7083
License Number StateKY
# 2
Primary TaxonomyN
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License Number7083
License Number StateKY
# 3
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License Number252311
License Number StateKY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: