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General NPI Number Information
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NPI Number | 1770082935
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Entity Type | Individual
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Provider Name | HEATHER RENEE EVERETT LISW-S
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Gender | Female
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Dates
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Enumeration Date | 02/02/2018
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Last Update Date | 02/02/2018
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Provider Practice Location Address
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Address Line | 10945 REED HARTMAN HWY STE 203
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City | BLUE ASH
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State | OH
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Zip | 45242-2853
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Country | US
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Telephone | 513-708-6833
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Fax |
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Provider Business Mailing Address
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Address Line | 6515 MINNEWAUKAN DR
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City | CINCINNATI
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State | OH
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Zip | 45243-2405
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Country | US
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Telephone | 513-708-6833
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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 | 1041C0700X
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Taxonomy Name | Clinical Social Worker
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License Number | 1.1100038
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License Number State | OH
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