Healthcare Provider Details

I. General information

NPI: 1679004709
Provider Name (Legal Business Name): HEATHER STONE LSW, CDCA
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 03/21/2017
Last Update Date: 07/21/2022
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

245 NEAL AVE
MOUNT GILEAD OH
43338-9372
US

IV. Provider business mailing address

245 NEAL AVE
MOUNT GILEAD OH
43338-9372
US

V. Phone/Fax

Practice location:
  • Phone: 419-946-6734
  • Fax: 419-946-6952
Mailing address:
  • Phone: 419-946-6734
  • Fax: 419-946-6952

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License NumberS.1700450
License Number StateOH
# 2
Primary TaxonomyN
Taxonomy Code101YA0400X
TaxonomyAddiction (Substance Use Disorder) Counselor
License Number130769
License Number StateOH

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: