Provider Demographics
NPI:1053852939
Name:HIROKI, HEATHER (MSW, LISW, LCDCIII)
Entity Type:Individual
Prefix:
First Name:HEATHER
Middle Name:
Last Name:HIROKI
Suffix:
Gender:F
Credentials:MSW, LISW, LCDCIII
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:949 TOWNSHIP ROAD 813
Mailing Address - Street 2:
Mailing Address - City:ASHLAND
Mailing Address - State:OH
Mailing Address - Zip Code:44805-8836
Mailing Address - Country:US
Mailing Address - Phone:419-496-8764
Mailing Address - Fax:
Practice Address - Street 1:2775 STATE ROUTE 39
Practice Address - Street 2:
Practice Address - City:SHELBY
Practice Address - State:OH
Practice Address - Zip Code:44875
Practice Address - Country:US
Practice Address - Phone:419-747-3322
Practice Address - Fax:419-747-3504
Is Sole Proprietor?:Yes
Enumeration Date:2017-03-13
Last Update Date:2020-07-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OHS.1500612324500000X
OH1613863245S0500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3245S0500XResidential Treatment FacilitiesSubstance Abuse Rehabilitation FacilitySubstance Abuse Treatment, Children
No324500000XResidential Treatment FacilitiesSubstance Abuse Rehabilitation Facility