Healthcare Provider Details

I. General information

NPI: 1932766136
Provider Name (Legal Business Name): CHRISTINE SUE HEFFRON LMSW
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 05/22/2019
Last Update Date: 05/22/2019
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5360 HOLIDAY TER STE 32
KALAMAZOO MI
49009-2126
US

IV. Provider business mailing address

58295 KRISTINA CIR W
PAW PAW MI
49079-8605
US

V. Phone/Fax

Practice location:
  • Phone: 269-251-1494
  • Fax:
Mailing address:
  • Phone: 269-929-0210
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License Number6801093479
License Number StateMI
# 2
Primary TaxonomyY
Taxonomy Code104100000X
TaxonomySocial Worker
License Number6801093479
License Number StateMI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: