Healthcare Provider Details

I. General information

NPI: 1326177833
Provider Name (Legal Business Name): RITA HEINZ LCSW
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 03/02/2007
Last Update Date: 04/22/2009
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

33 N CENTRAL AVE
MEDFORD OR
97501-5900
US

IV. Provider business mailing address

210 SUNCREST RD SUITE 3
TALENT OR
97540-8691
US

V. Phone/Fax

Practice location:
  • Phone: 541-512-0615
  • Fax:
Mailing address:
  • Phone: 541-512-0615
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License NumberL0771
License Number StateOR

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: