Healthcare Provider Details

I. General information

NPI: 1831205038
Provider Name (Legal Business Name): KATHRYN LUCILLE HEFFINGER LISW
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/21/2006
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1400 TOD AVE NW
WARREN OH
44485-2483
US

IV. Provider business mailing address

1645 E SOUTH RANGE RD
NORTH LIMA OH
44452-9535
US

V. Phone/Fax

Practice location:
  • Phone: 330-392-0311
  • Fax: 330-392-0323
Mailing address:
  • Phone: 330-549-3552
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License NumberI-0007708
License Number StateOH

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: