Healthcare Provider Details

I. General information

NPI: 1871807966
Provider Name (Legal Business Name): TESSA LEE HEUERMANN MSW
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: TESSA LEE JOHNSON MSW

II. Dates (important events)

Enumeration Date: 07/30/2010
Last Update Date: 09/30/2016
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3205 HARVARD AVE
BUTTE MT
59701-4551
US

IV. Provider business mailing address

3205 HARVARD AVE
BUTTE MT
59701-4551
US

V. Phone/Fax

Practice location:
  • Phone: 406-529-2254
  • Fax:
Mailing address:
  • Phone: 406-529-2254
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code104100000X
TaxonomySocial Worker
License NumberPCSW-417
License Number StateWY
# 3
Primary TaxonomyN
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License NumberPCSW-417
License Number StateWY
# 4
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License NumberBBH-LCSW-LIC-70
License Number StateMT

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: