Provider Demographics
NPI:1043749005
Name:REID, HEATHER L (LISW)
Entity Type:Individual
Prefix:
First Name:HEATHER
Middle Name:L
Last Name:REID
Suffix:
Gender:F
Credentials:LISW
Other - Prefix:
Other - First Name:HEATHER
Other - Middle Name:L
Other - Last Name:GEAR
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:3200 INGERSOLL AVE STE E
Mailing Address - Street 2:
Mailing Address - City:DES MOINES
Mailing Address - State:IA
Mailing Address - Zip Code:50312-3917
Mailing Address - Country:US
Mailing Address - Phone:515-729-3816
Mailing Address - Fax:
Practice Address - Street 1:3200 INGERSOLL AVE STE E
Practice Address - Street 2:
Practice Address - City:DES MOINES
Practice Address - State:IA
Practice Address - Zip Code:50312-3917
Practice Address - Country:US
Practice Address - Phone:515-729-3816
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2017-06-05
Last Update Date:2021-09-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IA0774721041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinicalGroup - Single Specialty