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General NPI Number Information
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NPI Number | 1972982775
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Entity Type | Individual
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Provider Name | HEATHER EDWALL MSW
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Gender | Female
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Dates
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Enumeration Date | 05/26/2015
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Last Update Date | 10/16/2023
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Provider Practice Location Address
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Address Line | 150 PIONEER LN
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City | BISHOP
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State | CA
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Zip | 93514-2556
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Country | US
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Telephone | 760-872-5811
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Fax |
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Provider Business Mailing Address
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Address Line | 284 PANORAMA DR
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City | BISHOP
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State | CA
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Zip | 93514-7021
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Country | US
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Telephone | 760-935-3812
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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 | LCSW-20246
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License Number State | AZ
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Taxonomy #2
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Taxonomy Code | 1041C0700X
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Taxonomy Name | Clinical Social Worker
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License Number | LCSW-41180
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License Number State | ID
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Taxonomy #3
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Taxonomy Code | 1041C0700X
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Taxonomy Name | Clinical Social Worker
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License Number | 9841-C
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License Number State | NV
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Taxonomy #4
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Taxonomy Code | 1041C0700X
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Taxonomy Name | Clinical Social Worker
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License Number | LCSW83415
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License Number State | CA
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