Healthcare Provider Details

I. General information

NPI: 1336435981
Provider Name (Legal Business Name): HEATHER MARIE KINSEY LSW
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/22/2011
Last Update Date: 06/22/2011
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1058 E BETHLEHEM BLVD
WHEELING WV
26003-4961
US

IV. Provider business mailing address

1058 E BETHLEHEM BLVD
WHEELING WV
26003-4961
US

V. Phone/Fax

Practice location:
  • Phone: 304-232-0587
  • Fax: 304-232-1031
Mailing address:
  • Phone: 304-232-0587
  • Fax: 304-232-1031

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code104100000X
TaxonomySocial Worker
License NumberS.0901412
License Number StateOH

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: