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NPI Code Detail

MEDICARE: LAURA N HEESACKER LCSW

MEDICARE: LAURA N HEESACKER 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 WorkerL4110OR

Other Identifiers

# Provider Identifier Provider Identifier Type Provider Identifier State Provider Identifier Issuer
1MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
2MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number : 1205818580
Entity Type Code : Individual
Provider Name (Legal Business Name) : LAURA N HEESACKER LCSW
Provider Business Mailing Address
First Line : 1656 ROSS LN
Second Line :
City : ASHLAND
State : OR
Zip : 97520-3429
Country : US
Telephone Number : 541-631-1128
Fax Number :
Provider Business Practice Location Address
First Line : 3617 S PACIFIC HWY
Second Line :
City : MEDFORD
State : OR
Zip : 97501-8957
Country : US
Telephone Number : 541-535-6239
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 11/14/2005
Last Update Date : 01/06/2026

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Directions to “ LAURA N HEESACKER LCSW” Practice Location

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