Provider Demographics
NPI:1083213383
Name:HEINHOLD, STEPHANIE (MSW)
Entity Type:Individual
Prefix:
First Name:STEPHANIE
Middle Name:
Last Name:HEINHOLD
Suffix:
Gender:F
Credentials:MSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5934 W BELLA ROSA CV
Mailing Address - Street 2:
Mailing Address - City:HERRIMAN
Mailing Address - State:UT
Mailing Address - Zip Code:84096-1791
Mailing Address - Country:US
Mailing Address - Phone:678-478-4217
Mailing Address - Fax:
Practice Address - Street 1:5934 W BELLA ROSA CV
Practice Address - Street 2:
Practice Address - City:HERRIMAN
Practice Address - State:UT
Practice Address - Zip Code:84096-1791
Practice Address - Country:US
Practice Address - Phone:678-478-4217
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2020-10-19
Last Update Date:2020-10-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101Y00000XBehavioral Health & Social Service ProvidersCounselor