Healthcare Provider Details

I. General information

NPI: 1679986186
Provider Name (Legal Business Name): HEATHER R GRAMME MSW, MSG
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/03/2014
Last Update Date: 09/13/2026
Certification Date: 09/13/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1782 HACKETT DR
LA PINE OR
97739-9118
US

IV. Provider business mailing address

25016 HENDON ST
LAGUNA HILLS CA
92653-4629
US

V. Phone/Fax

Practice location:
  • Phone: 442-245-4585
  • Fax:
Mailing address:
  • Phone: 442-245-4585
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License NumberLCSW86925
License Number StateCA
# 3
Primary TaxonomyN
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License Number171M500000X
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: