Healthcare Provider Details

I. General information

NPI: 1184942955
Provider Name (Legal Business Name): STEPHANIE ANN HEIMANN MSW, LCSW
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: STEPHANIE ANN HILLERMAN LCSW

II. Dates (important events)

Enumeration Date: 05/04/2010
Last Update Date: 10/15/2024
Certification Date: 10/15/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

210 N WILLIAMS ST UNIT C
MOBERLY MO
65270-1583
US

IV. Provider business mailing address

1300 E BRADFORD PKWY
SPRINGFIELD MO
65804-4264
US

V. Phone/Fax

Practice location:
  • Phone: 660-263-7651
  • Fax:
Mailing address:
  • Phone: 417-269-5400
  • Fax: 417-269-7212

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License Number2005018690
License Number StateMO

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: