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NPI Code Detail

MEDICARE: MS. SUSAN ANN HEATH LCSW

MEDICARE: MS. SUSAN ANN HEATH LCSW
Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

# Taxonomy Code Taxonomy License Number License Number State
11041C0700XClinical Social Worker0610OR

Other Identifiers

# Provider Identifier Provider Identifier Type Provider Identifier State Provider Identifier Issuer
10610OTHERORLCSW

General Provider Information

NPI Number : 1154477420
Entity Type Code : Individual
Provider Name (Legal Business Name) : MS. SUSAN ANN HEATH LCSW
Provider Business Mailing Address
First Line : 1247 HEATHER LN SE
Second Line :
City : SALEM
State : OR
Zip : 97302-1523
Country : US
Telephone Number : 503-999-2748
Fax Number : 503-585-3261
Provider Business Practice Location Address
First Line : 1845 COMMERCIAL ST SE
Second Line :
City : SALEM
State : OR
Zip : 97302-5203
Country : US
Telephone Number : 503-315-8575
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 01/26/2007
Last Update Date : 02/20/2008

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