Healthcare Provider Details

I. General information

NPI: 1720653231
Provider Name (Legal Business Name): SYDNEY PAIGE HEITKAMP LSW
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/26/2021
Last Update Date: 10/10/2023
Certification Date: 10/10/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

835 N LOCUST ST
OTTAWA OH
45875-1216
US

IV. Provider business mailing address

835 N LOCUST ST
OTTAWA OH
45875-1216
US

V. Phone/Fax

Practice location:
  • Phone: 419-523-4300
  • Fax:
Mailing address:
  • Phone: 419-423-4300
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code171M00000X
TaxonomyCase Manager/Care Coordinator
License Number
License Number State
# 2
Primary TaxonomyY
Taxonomy Code101Y00000X
TaxonomyCounselor
License NumberS.2207913
License Number StateOH

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: