MEDICARE: HEATHER GILMORE MSW, BCBA, LBA, IBA

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
1	103K00000X	Behavior Analyst	1-15-21286	MI

General Provider Information

NPI Number	:	1245657295
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	HEATHER GILMORE MSW, BCBA, LBA, IBA

Provider Business Mailing Address
First Line	:	211 MASON ST
Second Line	:
City	:	ALPENA
State	:	MI
Zip	:	49707-3611
Country	:	US
Telephone Number	:	989-284-7318
Fax Number	:

Provider Business Practice Location Address
First Line	:	314 INKSTER RD
Second Line	:
City	:	INKSTER
State	:	MI
Zip	:	48141-1209
Country	:	US
Telephone Number	:	989-284-7318
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	03/27/2014
Last Update Date	:	12/16/2025

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