Provider Demographics
NPI:1063835510
Name:HEIDERMAN, MARISSA (AA)
Entity Type:Individual
Prefix:
First Name:MARISSA
Middle Name:
Last Name:HEIDERMAN
Suffix:
Gender:F
Credentials:AA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:105 E NORFOLK AVE
Mailing Address - Street 2:SUITE 118
Mailing Address - City:NORFOLK
Mailing Address - State:NE
Mailing Address - Zip Code:68701-5323
Mailing Address - Country:US
Mailing Address - Phone:402-370-4204
Mailing Address - Fax:402-370-4206
Practice Address - Street 1:105 E NORFOLK AVE
Practice Address - Street 2:SUITE 118
Practice Address - City:NORFOLK
Practice Address - State:NE
Practice Address - Zip Code:68701-5323
Practice Address - Country:US
Practice Address - Phone:402-370-4204
Practice Address - Fax:402-370-4206
Is Sole Proprietor?:No
Enumeration Date:2014-02-03
Last Update Date:2015-02-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes104100000XBehavioral Health & Social Service ProvidersSocial Worker