Healthcare Provider Details

I. General information

NPI: 1013112366
Provider Name (Legal Business Name): REBECCA JOYCE HEISSERER LCSW
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 06/18/2007
Last Update Date: 11/19/2014
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2909 INDEPENDENCE ST
CAPE GIRARDEAU MO
63703-5044
US

IV. Provider business mailing address

2909 INDEPENDENCE ST
CAPE GIRARDEAU MO
63703-5044
US

V. Phone/Fax

Practice location:
  • Phone: 573-803-1402
  • Fax: 573-803-1405
Mailing address:
  • Phone: 573-803-1402
  • Fax: 573-803-1405

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License Number1246C
License Number StateAR

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: