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General NPI Number Information
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NPI Number | 1003194903
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Entity Type | Individual
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Provider Name | MELISSA MARIE HEIDEMANN LISW-S
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Gender | Female
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Dates
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Enumeration Date | 07/26/2011
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Last Update Date | 05/21/2025
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Provider Practice Location Address
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Address Line | 1848 THORNWOOD LN
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City | PAINESVILLE
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State | OH
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Zip | 44077-6151
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Country | US
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Telephone | 440-423-5933
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Fax |
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Provider Business Mailing Address
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Address Line | 1848 THORNWOOD LN
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City | PAINESVILLE
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State | OH
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Zip | 44077-6151
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Country | US
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Telephone | 440-423-5933
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 104100000X
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Taxonomy Name | Social Worker
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License Number | L.1100197-SUPV
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License Number State | OH
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