Healthcare Provider Details

I. General information

NPI: 1174640320
Provider Name (Legal Business Name): MONICA JO HEITER LCSW
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 03/23/2007
Last Update Date: 08/23/2018
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

206 N BISMARK ST STE A
CONCORDIA MO
64020
US

IV. Provider business mailing address

825 S BUSINESS HIGHWAY 13
LEXINGTON MO
64067-1515
US

V. Phone/Fax

Practice location:
  • Phone: 660-463-0234
  • Fax: 660-463-0266
Mailing address:
  • Phone: 660-259-2440
  • Fax: 660-251-0524

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License Number2006008225
License Number StateMO

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: